Provider Demographics
NPI:1063582534
Name:CHANG, ELAINE STACY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:STACY
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 1:658 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-2212
Mailing Address - Country:US
Mailing Address - Phone:310-257-6381
Mailing Address - Fax:310-257-6297
Practice Address - Street 1:25825 VERMONT AVE
Practice Address - Street 2:APT CLINIC - PARKVIEW 3RD FL, ROOM 3114
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-3518
Practice Address - Country:US
Practice Address - Phone:310-257-6215
Practice Address - Fax:310-257-6297
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA051930183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist