Provider Demographics
NPI:1609158518
Name:PARK, SUNGEUN JULIA (PHARM D)
Entity Type:Individual
Prefix:
First Name:SUNGEUN
Middle Name:JULIA
Last Name:PARK
Suffix:
Gender:F
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 1:65 FAIRVIEW ST APT 2I
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-1073
Mailing Address - Country:US
Mailing Address - Phone:347-554-0324
Mailing Address - Fax:
Practice Address - Street 1:72 CRESCENT AVE
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1345
Practice Address - Country:US
Practice Address - Phone:201-444-2754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03338600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist