Provider Demographics
NPI:1427079508
Name:CHANG GI HUH
Entity type:Organization
Organization Name:CHANG GI HUH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHANG
Authorized Official - Middle Name:G
Authorized Official - Last Name:HUH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:215-455-2411
Mailing Address - Street 1:5304 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-3204
Mailing Address - Country:US
Mailing Address - Phone:215-455-2411
Mailing Address - Fax:215-457-0469
Practice Address - Street 1:5304 N 5TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-3204
Practice Address - Country:US
Practice Address - Phone:215-455-2411
Practice Address - Fax:215-457-0469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP411883L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5086210001Medicare NSC