Provider Demographics
NPI:1972803971
Name:CHANG, GENINE DOAN (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:GENINE
Middle Name:DOAN
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 1:644 RIDGEMONT CIR
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-5114
Mailing Address - Country:US
Mailing Address - Phone:760-432-9987
Mailing Address - Fax:760-796-7584
Practice Address - Street 1:1000 W EL NORTE PKWY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-3341
Practice Address - Country:US
Practice Address - Phone:760-747-5910
Practice Address - Fax:760-796-7584
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54860183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist