Provider Demographics
NPI:1669921508
Name:CHANG, JANICE (PHARMD)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10940 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3725
Mailing Address - Country:US
Mailing Address - Phone:818-763-4334
Mailing Address - Fax:818-763-4610
Practice Address - Street 1:10940 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3725
Practice Address - Country:US
Practice Address - Phone:818-763-4334
Practice Address - Fax:818-763-4610
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 73215183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist