Provider Demographics
NPI:1710176201
Name:MUI-PARK, MICHELLE HING
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:HING
Last Name:MUI-PARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17100 SR 507 SE
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-7605
Mailing Address - Country:US
Mailing Address - Phone:360-400-8062
Mailing Address - Fax:360-400-8065
Practice Address - Street 1:17100 SR 507 SE
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-7605
Practice Address - Country:US
Practice Address - Phone:360-400-8062
Practice Address - Fax:360-400-8065
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8421183500000X
WAPH00067742183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist