Provider Demographics
NPI:1447528831
Name:CHANG, JENNIFER (PHARM D)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11003 LAKEWOOD BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-3876
Mailing Address - Country:US
Mailing Address - Phone:562-869-9200
Mailing Address - Fax:
Practice Address - Street 1:11003 LAKEWOOD BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241
Practice Address - Country:US
Practice Address - Phone:562-869-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2018-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54256183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist