Healthcare Provider Details

I. General information

NPI: 1740332584
Provider Name (Legal Business Name): JOUNG SUN PARK RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 149TH ST
BRONX NY
10451-5504
US

IV. Provider business mailing address

735 KAPPOCK ST APT 8D
BRONX NY
10463-4631
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-5864
  • Fax: 718-579-5003
Mailing address:
  • Phone: 718-543-3367
  • Fax: 718-579-5003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number035533-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: