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General NPI Number Information
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NPI Number | 1629328281
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Entity Type | Individual
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Provider Name | DIANA PARK PHARM.D
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Gender | Female
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Dates
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Enumeration Date | 09/11/2012
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Last Update Date | 09/11/2012
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Provider Practice Location Address
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Address Line | 4220 MISSOURI FLAT RD
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City | PLACERVILLE
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State | CA
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Zip | 95667-6269
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Country | US
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Telephone | 530-344-1062
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Fax |
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Provider Business Mailing Address
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Address Line | 9562 ROSE VISTA CT
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City | SACRAMENTO
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State | CA
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Zip | 95827-3268
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Country | US
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Telephone | 916-541-4622
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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 | 66645
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License Number State | CA
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