Provider Demographics
NPI:1295035103
Name:CHANG, SIV C (RPH)
Entity Type:Individual
Prefix:
First Name:SIV
Middle Name:C
Last Name:CHANG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 NE CIRCLE BLVD
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6828
Mailing Address - Country:US
Mailing Address - Phone:541-753-2970
Mailing Address - Fax:541-752-3510
Practice Address - Street 1:590 NE CIRCLE BLVD
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6828
Practice Address - Country:US
Practice Address - Phone:541-753-2970
Practice Address - Fax:541-752-3510
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8558183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist