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General NPI Number Information
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NPI Number | 1336436161
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Entity Type | Individual
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Provider Name | GLORIA Y PARK PHARM D
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Gender | Female
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Dates
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Enumeration Date | 06/30/2011
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Last Update Date | 06/30/2011
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Provider Practice Location Address
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Address Line | 8801 NE HAZEL DELL AVE T1883
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City | VANCOUVER
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State | WA
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Zip | 98665-8145
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Country | US
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Telephone | 360-713-0005
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Fax |
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Provider Business Mailing Address
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Address Line | 11765 SW 134TH TER
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City | TIGARD
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State | OR
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Zip | 97223-1581
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Country | US
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Telephone | 503-820-8750
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH60203858
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License Number State | WA
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