Provider Demographics
NPI:1144794264
Name:PARK, JANICE HYEJIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:HYEJIN
Last Name:PARK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16040 SIERRA PASS WAY
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-6544
Mailing Address - Country:US
Mailing Address - Phone:909-609-4088
Mailing Address - Fax:
Practice Address - Street 1:1421 MANHATTAN AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-5221
Practice Address - Country:US
Practice Address - Phone:657-243-0809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-12
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79792183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist