Healthcare Provider Details

I. General information

NPI: 1043623358
Provider Name (Legal Business Name): JAMES JUAN CHANG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37850 47TH ST E
PALMDALE CA
93552
US

IV. Provider business mailing address

37850 47TH ST E
PALMDALE CA
93552
US

V. Phone/Fax

Practice location:
  • Phone: 661-285-9473
  • Fax: 661-285-5040
Mailing address:
  • Phone: 661-285-9473
  • Fax: 661-285-5040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number70569
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: