Provider Demographics
NPI:1225371842
Name:PARK, HAE NA
Entity Type:Individual
Prefix:
First Name:HAE
Middle Name:NA
Last Name:PARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 NORTHVIEW DR
Mailing Address - Street 2:PHARMACY DEPARTMENT
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-2616
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4101 NORTHVIEW DR
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-2616
Practice Address - Country:US
Practice Address - Phone:301-262-7733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20692183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist