Provider Demographics
NPI:1245830652
Name:CHANG, JEANNIE HEE
Entity type:Individual
Prefix:
First Name:JEANNIE
Middle Name:HEE
Last Name:CHANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 CENTERVILLE ST
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-5672
Mailing Address - Country:US
Mailing Address - Phone:775-750-0465
Mailing Address - Fax:
Practice Address - Street 1:3200 MARKET ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-7984
Practice Address - Country:US
Practice Address - Phone:775-883-6535
Practice Address - Fax:775-883-6571
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12277183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist