Provider Demographics
NPI:1194359588
Name:PAK, CHINSU (PHARM D)
Entity Type:Individual
Prefix:
First Name:CHINSU
Middle Name:
Last Name:PAK
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 1:3099 BETHEL RD SE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-2432
Mailing Address - Country:US
Mailing Address - Phone:360-876-5212
Mailing Address - Fax:360-876-7444
Practice Address - Street 1:3099 BETHEL RD SE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-2432
Practice Address - Country:US
Practice Address - Phone:360-876-5212
Practice Address - Fax:360-876-7444
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60946738183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist