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General NPI Number Information
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NPI Number | 1790356954
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Entity Type | Individual
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Provider Name | MINWOO PARK PHARM.D., MHA
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Gender | Male
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Dates
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Enumeration Date | 07/08/2021
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 400 S 43RD ST
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City | RENTON
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State | WA
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Zip | 98055-5714
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Country | US
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Telephone | 509-833-9809
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Fax |
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Provider Business Mailing Address
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Address Line | 27579 214TH AVE SE
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City | MAPLE VALLEY
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State | WA
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Zip | 98038-3164
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Country | US
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Telephone | 509-833-9809
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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 | PH61183338
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License Number State | WA
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