Healthcare Provider Details

I. General information

NPI: 1669393492
Provider Name (Legal Business Name): JI YEON PARK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA PARK

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 07/25/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 AUBURN WAY S
AUBURN WA
98002-6348
US

IV. Provider business mailing address

1701 AUBURN WAY S
AUBURN WA
98002-6348
US

V. Phone/Fax

Practice location:
  • Phone: 253-394-0029
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHRM.PH.70041733
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: