Provider Demographics
NPI:1134313513
Name:CHANG, GRACE
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 E OCOTILLO RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-3013
Mailing Address - Country:US
Mailing Address - Phone:314-744-4109
Mailing Address - Fax:
Practice Address - Street 1:975 E OCOTILLO RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-3013
Practice Address - Country:US
Practice Address - Phone:314-744-4109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS014522183500000X
CA58519183500000X
AZ14522183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist