Provider Demographics
NPI:1881002111
Name:CHANG, TERESA R (PHARM D)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:R
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 1:455 W 37TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-4081
Mailing Address - Country:US
Mailing Address - Phone:347-558-1956
Mailing Address - Fax:
Practice Address - Street 1:455 W 37TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-4081
Practice Address - Country:US
Practice Address - Phone:347-558-1956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-30
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060283183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist