Provider Demographics
NPI:1376809319
Name:CHANG, PIL JAE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:PIL JAE
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 CLEMENTS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-2016
Mailing Address - Country:US
Mailing Address - Phone:856-384-6740
Mailing Address - Fax:
Practice Address - Street 1:2000 CLEMENTS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-2016
Practice Address - Country:US
Practice Address - Phone:856-384-6740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03093700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0193887Medicaid