Provider Demographics
NPI:1912185786
Name:PARK, KATHERINE HYUNJOO (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:HYUNJOO
Last Name:PARK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:HYUN
Other - Middle Name:JOO
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 POLIFLY RD
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-3209
Mailing Address - Country:US
Mailing Address - Phone:201-525-1149
Mailing Address - Fax:
Practice Address - Street 1:310 E 23RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4702
Practice Address - Country:US
Practice Address - Phone:212-505-1555
Practice Address - Fax:212-473-2774
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03200100183500000X
NY045299183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist