Healthcare Provider Details

I. General information

NPI: 1154700789
Provider Name (Legal Business Name): CHE MIN CHANG PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2015
Last Update Date: 05/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 BELLEVIEW AVE SE
ROANOKE VA
24014-1838
US

IV. Provider business mailing address

2768 CRICKLEWOOD CT
CHARLOTTESVILLE VA
22911-8286
US

V. Phone/Fax

Practice location:
  • Phone: 718-415-9477
  • Fax:
Mailing address:
  • Phone: 718-415-9477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number0202211486
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number5302041922
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: