MEDICARE: DR. EDWARD SUNG JOON PARK PHARM.D.

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	40831	TX

General Provider Information

NPI Number	:	1851420350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD SUNG JOON PARK PHARM.D.

Provider Business Mailing Address
First Line	:	4414 CEDAR SPRINGS RD APT 203
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-2029
Country	:	US
Telephone Number	:	214-934-7309
Fax Number	:	214-443-9403

Provider Business Practice Location Address
First Line	:	5939 HARRY HINES BLVD STE 845
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-6248
Country	:	US
Telephone Number	:	214-689-7806
Fax Number	:	214-879-1077

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

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	07/08/2007

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