MEDICARE: JAMIE PARK PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	56130	CA
2	183500000X	Pharmacist	56130	CA

General Provider Information

NPI Number	:	1215472774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE PARK PHARMD

Provider Business Mailing Address
First Line	:	3900 W 3RD ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-2675
Country	:	US
Telephone Number	:	213-382-4433
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 W 3RD ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-2675
Country	:	US
Telephone Number	:	213-382-4433
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2016
Last Update Date	:	05/09/2025

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Directions to “ JAMIE PARK PHARMD” Practice Location

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