Provider Demographics
NPI:1619299773
Name:CHANG, ALBERT VINCENT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:VINCENT
Last Name:CHANG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1189 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-4815
Mailing Address - Country:US
Mailing Address - Phone:718-702-0240
Mailing Address - Fax:
Practice Address - Street 1:1396 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4406
Practice Address - Country:US
Practice Address - Phone:212-249-5699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2010-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42693183500000X
NJ28RI03147900183500000X
NY051821183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist