MEDICARE: MR. SAMUEL VAN CHANG PHARM.D.

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	48800	CA

General Provider Information

NPI Number	:	1891882460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SAMUEL VAN CHANG PHARM.D.

Provider Business Mailing Address
First Line	:	3327 JUDAH ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-1324
Country	:	US
Telephone Number	:	415-682-8088
Fax Number	:	415-833-4711

Provider Business Practice Location Address
First Line	:	3327 JUDAH ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-1324
Country	:	US
Telephone Number	:	415-682-8088
Fax Number	:	415-833-4711

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	07/08/2007

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