Provider Demographics
NPI:1376215855
Name:PARK, SHINHEE (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:SHINHEE
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 102ND AVE NE APT 425
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-5642
Mailing Address - Country:US
Mailing Address - Phone:201-290-1198
Mailing Address - Fax:
Practice Address - Street 1:24008 SNOHOMISH WOODINVILLE RD
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-9743
Practice Address - Country:US
Practice Address - Phone:425-806-7728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-02
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61189201183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist