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General NPI Number Information
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NPI Number | 1083990048
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Entity Type | Individual
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Provider Name | MEEKYUNG PARK
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Gender | Female
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Dates
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Enumeration Date | 10/22/2011
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Last Update Date | 06/07/2016
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Provider Practice Location Address
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Address Line | 4397 SUDDERTH RD
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City | BUFORD
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State | GA
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Zip | 30518-8794
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Country | US
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Telephone | 678-546-8442
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Fax |
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Provider Business Mailing Address
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Address Line | 3863 BAXLEY PINE TRL
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City | SUWANEE
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State | GA
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Zip | 30024-8449
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Country | US
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Telephone | 404-200-7303
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Fax | 678-546-5916
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH023133
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 051291007
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License Number State | IL
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