MEDICARE: MRS. KWANG-SOOK CHANG RPH

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	30114	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407068372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KWANG-SOOK CHANG RPH

Provider Business Mailing Address
First Line	:	21 CAMBORNE CIR
Second Line	:
City	:	FAIRPORT
State	:	NY
Zip	:	14450-8918
Country	:	US
Telephone Number	:	585-377-1896
Fax Number	:	585-377-1896

Provider Business Practice Location Address
First Line	:	3220 MONROE AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14618-4608
Country	:	US
Telephone Number	:	585-383-1630
Fax Number	:	585-383-1425

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

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	07/09/2007

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