Provider Demographics
NPI:1669516878
Name:CHANG, STEVEN H (RPH)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:H
Last Name:CHANG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2838 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-6326
Mailing Address - Country:US
Mailing Address - Phone:609-345-5105
Mailing Address - Fax:609-345-8892
Practice Address - Street 1:2838 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-6326
Practice Address - Country:US
Practice Address - Phone:609-345-5105
Practice Address - Fax:609-345-8892
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01529600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI01529600OtherPHARMACIST LICENSE