Provider Demographics
NPI:1437593027
Name:PAK, IAN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:
Last Name:PAK
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 1:77 GREEN ACRES RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-1008
Mailing Address - Country:US
Mailing Address - Phone:516-887-5128
Mailing Address - Fax:
Practice Address - Street 1:77 GREEN ACRES RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1008
Practice Address - Country:US
Practice Address - Phone:516-887-5128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-25
Last Update Date:2014-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057909183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist