Provider Demographics
NPI:1528577939
Name:PAK, GINA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:
Last Name:PAK
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 1:2257 JOURNET DR
Mailing Address - Street 2:
Mailing Address - City:DUNN LORING
Mailing Address - State:VA
Mailing Address - Zip Code:22027-1166
Mailing Address - Country:US
Mailing Address - Phone:703-401-3793
Mailing Address - Fax:
Practice Address - Street 1:7373 BOSTON BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22153-2805
Practice Address - Country:US
Practice Address - Phone:703-912-9062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH100002986183500000X
VA0202215959183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist