Provider Demographics
NPI:1285205021
Name:PARK, HYUN-SOOK (PHARMD)
Entity Type:Individual
Prefix:
First Name:HYUN-SOOK
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 HARRIS DR
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-4437
Mailing Address - Country:US
Mailing Address - Phone:860-977-8674
Mailing Address - Fax:860-262-5679
Practice Address - Street 1:1000 SILVER STREET
Practice Address - Street 2:PAGE HALL
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3947
Practice Address - Country:US
Practice Address - Phone:860-262-5000
Practice Address - Fax:860-262-5679
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0011720183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist