Provider Demographics
NPI:1992107593
Name:CHANG, GARY SHU-HAO (PHARM D)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:SHU-HAO
Last Name:CHANG
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8708 124TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5852
Mailing Address - Country:US
Mailing Address - Phone:425-889-7496
Mailing Address - Fax:
Practice Address - Street 1:15100 SE 38TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1728
Practice Address - Country:US
Practice Address - Phone:425-746-4028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60475009183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist