Provider Demographics
NPI:1710261243
Name:PARK, GRACE EUNHYE (PHARM D)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:EUNHYE
Last Name:PARK
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:EUNHYE
Other - Last Name:YANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125-133 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-2543
Mailing Address - Country:US
Mailing Address - Phone:212-529-7140
Mailing Address - Fax:212-529-7145
Practice Address - Street 1:125-133 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2543
Practice Address - Country:US
Practice Address - Phone:212-529-7140
Practice Address - Fax:212-529-7145
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist