MEDICARE: DASEUL PARK

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	183500000X	Pharmacist	20053046	NY

General Provider Information

NPI Number	:	1770932246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DASEUL PARK

Provider Business Mailing Address
First Line	:	235 E 95TH ST
Second Line	:	APT #30L
City	:	NEW YORK
State	:	NY
Zip	:	10128-4012
Country	:	US
Telephone Number	:	646-785-6349
Fax Number	:

Provider Business Practice Location Address
First Line	:	1752 PARK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10035-2811
Country	:	US
Telephone Number	:	646-785-6349
Fax Number	:

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

Provider Enumeration Date	:	06/06/2016
Last Update Date	:	06/06/2016

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Directions to “ DASEUL PARK ” Practice Location

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