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NPI Code Detail

MEDICARE: DR. KELLY CHANG PHARMD

MEDICARE:  DR. KELLY  CHANG  PHARMD
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
1183500000XPharmacist64155CA

General Provider Information

NPI Number : 1255647103
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KELLY CHANG PHARMD
Provider Business Mailing Address
First Line : 5551 SEASIDE HEIGHTS DR
Second Line :
City : RANCHO PALOS VERDES
State : CA
Zip : 90275-4932
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5551 SEASIDE HEIGHTS DR
Second Line :
City : RANCHO PALOS VERDES
State : CA
Zip : 90275-4932
Country : US
Telephone Number : 310-541-0694
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2010
Last Update Date : 08/28/2010

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Directions to “ DR. KELLY CHANG PHARMD” Practice Location

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