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General NPI Number Information
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NPI Number | 1538975503
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Entity Type | Individual
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Provider Name | BYUNGHOON PARK
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Gender | Male
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Dates
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Enumeration Date | 12/05/2024
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 609 E MAIN ST STE Q
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City | PURCELLVILLE
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State | VA
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Zip | 20132-3182
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Country | US
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Telephone | 540-751-9750
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Fax |
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Provider Business Mailing Address
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Address Line | 43198 LOUDOUN RESERVE DR
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City | ASHBURN
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State | VA
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Zip | 20148-7022
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Country | US
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Telephone | 715-289-9785
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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 | 0202222491
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License Number State | VA
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