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General NPI Number Information
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NPI Number | 1407068372
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Entity Type | Individual
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Provider Name | KWANG-SOOK CHANG RPH
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Gender | Female
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 3220 MONROE AVE
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City | ROCHESTER
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State | NY
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Zip | 14618-4608
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Country | US
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Telephone | 585-383-1630
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Fax | 585-383-1425
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Provider Business Mailing Address
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Address Line | 21 CAMBORNE CIR
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City | FAIRPORT
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State | NY
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Zip | 14450-8918
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Country | US
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Telephone | 585-377-1896
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Fax | 585-377-1896
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 30114
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License Number State | NY
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