Provider Demographics
NPI:1043591258
Name:PARK, KWANG H (PHARM D)
Entity Type:Individual
Prefix:
First Name:KWANG
Middle Name:H
Last Name:PARK
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 CONCORD PIKE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-1403
Mailing Address - Country:US
Mailing Address - Phone:302-478-4335
Mailing Address - Fax:302-478-8715
Practice Address - Street 1:3513 N MARKET ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-2733
Practice Address - Country:US
Practice Address - Phone:302-357-3470
Practice Address - Fax:302-357-3476
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA10003842183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist