Provider Demographics
NPI:1003104621
Name:PARK, ANNA (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 JOHN F KENNEDY BLVD
Mailing Address - Street 2:APT 202
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-5751
Mailing Address - Country:US
Mailing Address - Phone:551-200-1484
Mailing Address - Fax:
Practice Address - Street 1:52 RIVER DR S
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07310-2787
Practice Address - Country:US
Practice Address - Phone:201-216-1117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-17
Last Update Date:2011-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03411800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist