Provider Demographics
NPI:1740304351
Name:PARK, IN PYO PETER (PHARMD)
Entity type:Individual
Prefix:
First Name:IN PYO PETER
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:IN PYO
Other - Middle Name:
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5285 MEADOWS ROAD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035
Mailing Address - Country:US
Mailing Address - Phone:503-785-9936
Mailing Address - Fax:610-335-4001
Practice Address - Street 1:5285 MEADOWS ROAD
Practice Address - Street 2:SUITE 320
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035
Practice Address - Country:US
Practice Address - Phone:503-785-9936
Practice Address - Fax:610-335-4001
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH0012461183500000X
WAPH60209174183500000X
VA0202214417183500000X
FLPS41685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist