Provider Demographics
NPI:1962838250
Name:CHANG, YULEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:YULEE
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-5108
Mailing Address - Country:US
Mailing Address - Phone:707-964-4058
Mailing Address - Fax:707-964-1729
Practice Address - Street 1:660 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-5108
Practice Address - Country:US
Practice Address - Phone:707-964-4058
Practice Address - Fax:707-964-1729
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2014-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69438183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist