Healthcare Provider Details

I. General information

NPI: 1801406095
Provider Name (Legal Business Name): JANICE FLORA PARK PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 BROADWAY
OAKLAND CA
94611-5613
US

IV. Provider business mailing address

3900 MILLBROOK DR
SANTA ROSA CA
95404-7613
US

V. Phone/Fax

Practice location:
  • Phone: 510-752-1244
  • Fax:
Mailing address:
  • Phone: 707-775-8836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number80746
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: