Provider Demographics
NPI:1821375429
Name:PAIK, YEONSHIN REGINA
Entity Type:Individual
Prefix:MRS
First Name:YEONSHIN
Middle Name:REGINA
Last Name:PAIK
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 1:63 W 87TH ST
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-2200
Mailing Address - Country:US
Mailing Address - Phone:630-778-7645
Mailing Address - Fax:
Practice Address - Street 1:63 W 87TH ST
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-2200
Practice Address - Country:US
Practice Address - Phone:630-778-7645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.040403183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist