MEDICARE: HYEWON 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	28RI04150900	NJ

General Provider Information

NPI Number	:	1235846320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HYEWON PARK

Provider Business Mailing Address
First Line	:	1400 ANDERSON AVE STE 7
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-4470
Country	:	US
Telephone Number	:	201-224-8877
Fax Number	:	201-224-8871

Provider Business Practice Location Address
First Line	:	1400 ANDERSON AVE STE 7
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-4470
Country	:	US
Telephone Number	:	201-224-8877
Fax Number	:	201-224-8871

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

Provider Enumeration Date	:	10/31/2022
Last Update Date	:	10/31/2022

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Directions to “ HYEWON PARK ” Practice Location

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