Provider Demographics
NPI:1720388820
Name:PARK, RACHEL JIYOUNG
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:JIYOUNG
Last Name: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 1:13814 OUTLET DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-4970
Mailing Address - Country:US
Mailing Address - Phone:301-890-7015
Mailing Address - Fax:301-890-0258
Practice Address - Street 1:13814 OUTLET DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-4970
Practice Address - Country:US
Practice Address - Phone:301-890-7015
Practice Address - Fax:301-890-0258
Is Sole Proprietor?:No
Enumeration Date:2010-10-24
Last Update Date:2010-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18442183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist