Healthcare Provider Details

I. General information

NPI: 1265342331
Provider Name (Legal Business Name): SEOYEON PARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 CONCORD PIKE
WILMINGTON DE
19803-1718
US

IV. Provider business mailing address

4020 CONCORD PIKE
WILMINGTON DE
19803-1718
US

V. Phone/Fax

Practice location:
  • Phone: 302-478-1510
  • Fax: 302-478-1973
Mailing address:
  • Phone: 302-478-1510
  • Fax: 302-478-1973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA1-0016031
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: