Healthcare Provider Details

I. General information

NPI: 1821574898
Provider Name (Legal Business Name): JENNY CHANG PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 E BROADWAY
DERRY NH
03038-2422
US

IV. Provider business mailing address

133 ENGLISH VILLAGE RD APT 304
MANCHESTER NH
03102-2439
US

V. Phone/Fax

Practice location:
  • Phone: 603-434-2600
  • Fax:
Mailing address:
  • Phone: 917-216-2226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPHCY-04447
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: