Healthcare Provider Details

I. General information

NPI: 1306176151
Provider Name (Legal Business Name): CHANGHONG PENG PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2009
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 BROADWAY E
SEATTLE WA
98102-5009
US

IV. Provider business mailing address

417 BROADWAY E
SEATTLE WA
98102-5009
US

V. Phone/Fax

Practice location:
  • Phone: 206-323-6586
  • Fax: 206-328-6960
Mailing address:
  • Phone: 206-323-6586
  • Fax: 206-328-6960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH60086005
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: