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General NPI Number Information
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NPI Number | 1063331205
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Entity Type | Individual
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Provider Name | DR. JAMES PARK
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Gender | Male
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Dates
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Enumeration Date | 07/13/2026
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Last Update Date | 07/13/2026
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Provider Practice Location Address
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Address Line | 4228 LOWER PARK DR
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City | FAIRFAX
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State | VA
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Zip | 22030-8515
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Country | US
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Telephone | 412-228-0298
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Fax |
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Provider Business Mailing Address
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Address Line | 4228 LOWER PARK DR
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City | FAIRFAX
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State | VA
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Zip | 22030-8515
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835G0303X
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Taxonomy Name | Geriatric Pharmacist
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License Number | PH100001659
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License Number State | DC
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