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General NPI Number Information
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NPI Number | 1578045340
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Entity Type | Individual
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Provider Name | YOUNG JAE PARK PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/29/2018
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Last Update Date | 08/29/2018
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Provider Practice Location Address
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Address Line | 459 PATTERSON RD
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City | HONOLULU
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State | HI
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Zip | 96819-1522
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Country | US
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Telephone | 808-433-3157
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Fax |
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Provider Business Mailing Address
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Address Line | 909 ALA LILIKOI ST APT 408
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City | HONOLULU
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State | HI
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Zip | 96818-2437
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Country | US
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Telephone | 678-602-1259
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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 | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | RPH029950
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License Number State | GA
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