Provider Demographics
NPI:1871630343
Name:CHANGCHIEN, YUEH-CHEAU GRACE (RPH)
Entity Type:Individual
Prefix:
First Name:YUEH-CHEAU
Middle Name:GRACE
Last Name:CHANGCHIEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 E VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3607
Mailing Address - Country:US
Mailing Address - Phone:626-307-5517
Mailing Address - Fax:626-307-0893
Practice Address - Street 1:808 E VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3607
Practice Address - Country:US
Practice Address - Phone:626-307-5517
Practice Address - Fax:626-307-0893
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY41511183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA415110Medicaid
CAPHA415110Medicaid