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General NPI Number Information
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NPI Number | 1659556819
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Entity Type | Individual
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Provider Name | MS. SEON JUNG SHELLY PARK
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Gender | Female
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Dates
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Enumeration Date | 01/07/2008
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Last Update Date | 09/28/2015
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Provider Practice Location Address
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Address Line | 67 BROAD ST
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City | NEW YORK
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State | NY
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Zip | 10004-2415
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Country | US
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Telephone | 212-943-3690
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Fax | 212-425-1945
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Provider Business Mailing Address
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Address Line | 18930 37TH AVE UNIT B
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City | FLUSHING
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State | NY
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Zip | 11358-2302
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Country | US
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Telephone | 646-262-5161
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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 | 046554
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License Number State | NY
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