Provider Demographics
NPI:1487818183
Name:CHANG, CHOI KAM (RPH)
Entity Type:Individual
Prefix:
First Name:CHOI KAM
Middle Name:
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 1:8277 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-3352
Mailing Address - Country:US
Mailing Address - Phone:718-672-7781
Mailing Address - Fax:718-565-7298
Practice Address - Street 1:8277 BROADWAY
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-3352
Practice Address - Country:US
Practice Address - Phone:718-672-7781
Practice Address - Fax:718-565-7298
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048207183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist