Provider Demographics
NPI:1891018545
Name:PARK, BO K (RPH)
Entity Type:Individual
Prefix:MISS
First Name:BO
Middle Name:K
Last Name:PARK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 S SERVICE RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-4100
Mailing Address - Country:US
Mailing Address - Phone:516-396-8858
Mailing Address - Fax:800-880-9022
Practice Address - Street 1:45 S SERVICE RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4100
Practice Address - Country:US
Practice Address - Phone:516-396-8858
Practice Address - Fax:800-880-9022
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045567183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist