Provider Demographics
NPI:1760706402
Name:CHANG, EDWARD H (RPH)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:H
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 1:23 DWIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-3104
Mailing Address - Country:US
Mailing Address - Phone:718-409-0908
Mailing Address - Fax:
Practice Address - Street 1:23 DWIGHT AVE
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-3104
Practice Address - Country:US
Practice Address - Phone:718-409-0908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032840183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist