MEDICARE: CHANG GI HUH

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	3336C0003X	Community/Retail Pharmacy	PP411883L	PA

General Provider Information

NPI Number	:	1427079508
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHANG GI HUH

Provider Business Mailing Address
First Line	:	5304 N 5TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19120-3204
Country	:	US
Telephone Number	:	215-455-2411
Fax Number	:	215-457-0469

Provider Business Practice Location Address
First Line	:	5304 N 5TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19120-3204
Country	:	US
Telephone Number	:	215-455-2411
Fax Number	:	215-457-0469

Authorized Official
Title or Position	:	PHARMACIST MANAGER
Name	:	CHANG G HUH
Credential	:	PHARMACIST
Telephone Number	:	215-455-2411

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	06/20/2008

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