Provider Demographics
NPI:1780284323
Name:CHANG, JEN-CHIEH (REGISTER PHARMACIST)
Entity type:Individual
Prefix:
First Name:JEN-CHIEH
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:REGISTER PHARMACIST
Other - Prefix:
Other - First Name:JASON
Other - Middle Name:
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:201 N NELLIS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-5321
Mailing Address - Country:US
Mailing Address - Phone:702-452-8118
Mailing Address - Fax:702-452-1340
Practice Address - Street 1:201 N NELLIS BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-5321
Practice Address - Country:US
Practice Address - Phone:702-452-8118
Practice Address - Fax:702-452-1340
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14596183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist