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General NPI Number Information
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NPI Number | 1750734679
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Entity Type | Individual
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Provider Name | STEPHANIE MICHELLE CHANG PHARMD
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Gender | Female
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Dates
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Enumeration Date | 07/15/2016
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Last Update Date | 07/15/2016
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Provider Practice Location Address
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Address Line | 520 LARKFIELD RD
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City | EAST NORTHPORT
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State | NY
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Zip | 11731-4202
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Country | US
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Telephone | 631-368-4433
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Fax |
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Provider Business Mailing Address
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Address Line | 164 WOODHULL RD
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City | HUNTINGTON
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State | NY
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Zip | 11743-3742
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Country | US
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Telephone | 631-355-6286
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Fax |
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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 | 061749
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License Number State | NY
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