Provider Demographics
NPI:1710288048
Name:CHANG, KRISTINA Y (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:Y
Last Name:CHANG
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 W FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3846
Mailing Address - Country:US
Mailing Address - Phone:909-981-1114
Mailing Address - Fax:909-981-1373
Practice Address - Street 1:81 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3846
Practice Address - Country:US
Practice Address - Phone:909-981-1114
Practice Address - Fax:909-981-1373
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51843183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist