Provider Demographics
NPI:1467923086
Name:PARK, EUN YOUNG (PHARMD)
Entity Type:Individual
Prefix:
First Name:EUN YOUNG
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ELLIE
Other - Middle Name:
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1820 LEGENDS LN APT 5205
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-0010
Mailing Address - Country:US
Mailing Address - Phone:703-625-7206
Mailing Address - Fax:
Practice Address - Street 1:5100 E ST HWY 100
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2365
Practice Address - Country:US
Practice Address - Phone:386-313-3952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-07
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202217211183500000X
FLPS63923183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist