Healthcare Provider Details

I. General information

NPI: 1225755713
Provider Name (Legal Business Name): STEPHANIE JIHYUN PARK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 NE 162ND AVE STE 500
VANCOUVER WA
98682-3864
US

IV. Provider business mailing address

6700 NE 162ND AVE STE 500
VANCOUVER WA
98682-3864
US

V. Phone/Fax

Practice location:
  • Phone: 360-944-2680
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH87017
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: