Healthcare Provider Details

I. General information

NPI: 1396654455
Provider Name (Legal Business Name): HYEWON PARK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N SENATE BLVD
INDIANAPOLIS IN
46202-1239
US

IV. Provider business mailing address

4545 MARCY LN APT 270
INDIANAPOLIS IN
46205-5049
US

V. Phone/Fax

Practice location:
  • Phone: 309-706-6862
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26032101A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: