Healthcare Provider Details

I. General information

NPI: 1669919015
Provider Name (Legal Business Name): BARRY K CHANG PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2017
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 W. COVELL BLVD #1002
DAVIS CA
95616
US

IV. Provider business mailing address

2660 W COVELL BLVD # 1002
DAVIS CA
95616-5645
US

V. Phone/Fax

Practice location:
  • Phone: 530-747-3051
  • Fax:
Mailing address:
  • Phone: 530-747-3051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number44826
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: