Provider Demographics
NPI:1891882460
Name:CHANG, SAMUEL VAN (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:VAN
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 1:3327 JUDAH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-1324
Mailing Address - Country:US
Mailing Address - Phone:415-682-8088
Mailing Address - Fax:415-833-4711
Practice Address - Street 1:3327 JUDAH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-1324
Practice Address - Country:US
Practice Address - Phone:415-682-8088
Practice Address - Fax:415-833-4711
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist