Provider Demographics
NPI:1124357058
Name:PARK, JEONG YEAN (RPH)
Entity Type:Individual
Prefix:
First Name:JEONG
Middle Name:YEAN
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 1:14510 AURORA AVE N
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-6525
Mailing Address - Country:US
Mailing Address - Phone:206-361-8826
Mailing Address - Fax:206-363-3512
Practice Address - Street 1:14510 AURORA AVE N
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-6525
Practice Address - Country:US
Practice Address - Phone:206-361-8826
Practice Address - Fax:206-363-3512
Is Sole Proprietor?:No
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00067870183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist