MEDICARE: DR. WEN CHI CHANG PHARM. D.

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	052387	NY

General Provider Information

NPI Number	:	1992978704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WEN CHI CHANG PHARM. D.

Provider Business Mailing Address
First Line	:	13249 41ST RD
Second Line	:	APT# 2A
City	:	FLUSHING
State	:	NY
Zip	:	11355-4286
Country	:	US
Telephone Number	:	917-880-7316
Fax Number	:

Provider Business Practice Location Address
First Line	:	1082 2ND AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-2802
Country	:	US
Telephone Number	:	212-223-1130
Fax Number	:

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

Provider Enumeration Date	:	04/12/2008
Last Update Date	:	04/12/2008

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