Provider Demographics
NPI:1316232127
Name:CHANG, TINA (PHARMD)
Entity type:Individual
Prefix:
First Name:TINA
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 1:8500 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-2703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8500 S MAIN ST
Practice Address - Street 2:T1336
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-2703
Practice Address - Country:US
Practice Address - Phone:713-661-8213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47534183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist