Provider Demographics
NPI:1467210401
Name:PARK, AHYOUNG LYOO (PHARMD)
Entity Type:Individual
Prefix:
First Name:AHYOUNG
Middle Name:LYOO
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 1:1000 FOREST LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-4112
Mailing Address - Country:US
Mailing Address - Phone:404-550-4858
Mailing Address - Fax:
Practice Address - Street 1:26025 LAHSER RD FL 2
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-2606
Practice Address - Country:US
Practice Address - Phone:248-663-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIQ764778183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist