Provider Demographics
NPI:1336493899
Name:PARK, JI-HYE (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:JI-HYE
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 1:708 MULLEN ST
Mailing Address - Street 2:APT C2
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-3569
Mailing Address - Country:US
Mailing Address - Phone:412-295-9498
Mailing Address - Fax:
Practice Address - Street 1:906 E OLIVE ST
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052-2966
Practice Address - Country:US
Practice Address - Phone:719-336-2540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19687183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist