Provider Demographics
NPI:1851420350
Name:PARK, EDWARD SUNG JOON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:SUNG JOON
Last Name:PARK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4414 CEDAR SPRINGS RD APT 203
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-2029
Mailing Address - Country:US
Mailing Address - Phone:214-934-7309
Mailing Address - Fax:214-443-9403
Practice Address - Street 1:5939 HARRY HINES BLVD STE 845
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-6248
Practice Address - Country:US
Practice Address - Phone:214-689-7806
Practice Address - Fax:214-879-1077
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40831183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist