MEDICARE: MR. WONYOL CHANG RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RI28361	NJ

General Provider Information

NPI Number	:	1457670556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WONYOL CHANG RPH

Provider Business Mailing Address
First Line	:	2468 LEMOINE AVE
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-6206
Country	:	US
Telephone Number	:	201-944-1002
Fax Number	:	201-944-6336

Provider Business Practice Location Address
First Line	:	2468 LEMOINE AVE
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-6206
Country	:	US
Telephone Number	:	201-944-1002
Fax Number	:	201-944-6336

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2010
Last Update Date	:	02/26/2024

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