Provider Demographics
NPI:1578155222
Name:CHANG, MARA YEE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARA
Middle Name:YEE
Last Name:CHANG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:MARA
Other - Middle Name:YEE
Other - Last Name:OTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:8649 PROVIDENT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-1607
Mailing Address - Country:US
Mailing Address - Phone:412-523-7770
Mailing Address - Fax:
Practice Address - Street 1:526 PENN ST STE 2
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19602-1097
Practice Address - Country:US
Practice Address - Phone:610-750-6761
Practice Address - Fax:610-750-6723
Is Sole Proprietor?:No
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP454139183500000X
NC28644183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist