Provider Demographics
NPI:1457670556
Name:CHANG, WONYOL (RPH)
Entity Type:Individual
Prefix:MR
First Name:WONYOL
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2468 LEMOINE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6206
Mailing Address - Country:US
Mailing Address - Phone:201-944-1002
Mailing Address - Fax:201-944-6336
Practice Address - Street 1:2468 LEMOINE AVE
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6206
Practice Address - Country:US
Practice Address - Phone:201-944-1002
Practice Address - Fax:201-944-6336
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI28361183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist