Provider Demographics
NPI:1508185034
Name:CHANG, DICK (RPH)
Entity Type:Individual
Prefix:
First Name:DICK
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 1:735 E ALTADENA DR
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-2302
Mailing Address - Country:US
Mailing Address - Phone:626-791-7935
Mailing Address - Fax:
Practice Address - Street 1:735 E ALTADENA DR
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-2302
Practice Address - Country:US
Practice Address - Phone:626-791-7935
Practice Address - Fax:626-791-7916
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2010-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36876183500000X
NV08259183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist