Provider Demographics
NPI:1346522257
Name:PARK, DANIEL (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:PARK
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 1:6940 GREGORICH DR
Mailing Address - Street 2:UNIT# H
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138-1948
Mailing Address - Country:US
Mailing Address - Phone:626-422-0552
Mailing Address - Fax:
Practice Address - Street 1:1414 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-5102
Practice Address - Country:US
Practice Address - Phone:650-637-9777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63436183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist