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General NPI Number Information
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NPI Number | 1841896206
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Entity Type | Individual
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Provider Name | JUSTIN KYOUK PARK PHARMD
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Gender | Male
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Dates
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Enumeration Date | 12/09/2020
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Last Update Date | 12/09/2020
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Provider Practice Location Address
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Address Line | 45 PEARL ST
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City | METUCHEN
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State | NJ
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Zip | 08840-1832
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Country | US
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Telephone | 732-516-0089
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Fax |
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Provider Business Mailing Address
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Address Line | 1155 N ELLIE ST
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City | LA HABRA
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State | CA
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Zip | 90631-3995
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Country | US
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Telephone | 714-328-6506
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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 | 28RI04084400
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License Number State | NJ
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