Healthcare Provider Details

I. General information

NPI: 1205204112
Provider Name (Legal Business Name): KATIE B CHANG RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 N BECKLEY AVE
DALLAS TX
75203-1201
US

IV. Provider business mailing address

2335 CLARK ST
DALLAS TX
75204-2826
US

V. Phone/Fax

Practice location:
  • Phone: 214-947-2400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number34497
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: