MEDICARE: JULIE SON PARK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	59601	CA
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	59601	CA

General Provider Information

NPI Number	:	1134406598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE SON PARK

Provider Business Mailing Address
First Line	:	3350 LA SIERRA AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92503-5228
Country	:	US
Telephone Number	:	951-637-9819
Fax Number	:

Provider Business Practice Location Address
First Line	:	3350 LA SIERRA AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92503-5228
Country	:	US
Telephone Number	:	951-637-9819
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2011
Last Update Date	:	05/27/2026

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Directions to “ JULIE SON PARK ” Practice Location

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