Provider Demographics
NPI:1063119824
Name:CHANG, MARY EUN HYE (PHARMD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:EUN HYE
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 1:1329 UNIVERSITY BLVD E
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-7445
Mailing Address - Country:US
Mailing Address - Phone:301-445-8159
Mailing Address - Fax:
Practice Address - Street 1:1329 UNIVERSITY BLVD E
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-7445
Practice Address - Country:US
Practice Address - Phone:301-445-8159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28972183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist