MEDICARE: MR. THOMAS CHANG UHM R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	045897	NY
2	183500000X	Pharmacist	28RI02802400	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	28RI02802400	OTHER	NJ	NEW JERSEY BOARD OF PHARMACY
2	045897	OTHER	NY	NEW YORK STATE BOARD OF PHARMACY

General Provider Information

NPI Number	:	1093045767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS CHANG UHM R.PH.

Provider Business Mailing Address
First Line	:	1437 14TH ST
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-2006
Country	:	US
Telephone Number	:	551-486-0343
Fax Number	:	718-324-1818

Provider Business Practice Location Address
First Line	:	1437 14TH ST
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-2006
Country	:	US
Telephone Number	:	551-486-0343
Fax Number	:	718-324-1818

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2010
Last Update Date	:	01/02/2010

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