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NPI Code Detail

MEDICARE: JONG-BEAK PARK R.PH., PH.D.

MEDICARE: JONG-BEAK PARK R.PH., PH.D.
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
1183500000XPharmacist5302038479MI

General Provider Information

NPI Number : 1679717144
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONG-BEAK PARK R.PH., PH.D.
Provider Business Mailing Address
First Line : 3051 SANDY PLAINS RD
Second Line :
City : MARIETTA
State : GA
Zip : 30066-4721
Country : US
Telephone Number : 770-977-7661
Fax Number :
Provider Business Practice Location Address
First Line : 3051 SANDY PLAINS RD
Second Line :
City : MARIETTA
State : GA
Zip : 30066-4721
Country : US
Telephone Number : 770-977-7661
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2009
Last Update Date : 09/11/2025

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