Provider Demographics
NPI:1013185958
Name:PARK, JI YUN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JI
Middle Name:YUN
Last Name:PARK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 15TH ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07648-2306
Mailing Address - Country:US
Mailing Address - Phone:917-291-4331
Mailing Address - Fax:
Practice Address - Street 1:568-574 W 125TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027
Practice Address - Country:US
Practice Address - Phone:212-865-3894
Practice Address - Fax:212-865-2382
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046832183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist