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General NPI Number Information
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NPI Number | 1689162224
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Entity Type | Individual
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Provider Name | SO YEUN PARK PHARMD
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Gender | Female
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Dates
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Enumeration Date | 04/30/2018
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Last Update Date | 04/30/2018
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Provider Practice Location Address
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Address Line | 242 PALISADE AVE
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City | GARFIELD
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State | NJ
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Zip | 07026-2967
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Country | US
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Telephone | 877-469-4334
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Fax | 888-987-4763
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Provider Business Mailing Address
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Address Line | 373 E MAIN ST APT 102
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City | SOMERVILLE
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State | NJ
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Zip | 08876-3130
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Country | US
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Telephone | 574-780-6159
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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 | 28RI03893900
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License Number State | NJ
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