Provider Demographics
NPI:1750992533
Name:PARK, YEON JOON (PHARMD)
Entity type:Individual
Prefix:
First Name:YEON JOON
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:YEON
Other - Middle Name:
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8700 FREEPORT PKWY STE 100A
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-1920
Mailing Address - Country:US
Mailing Address - Phone:469-957-3937
Mailing Address - Fax:469-957-3938
Practice Address - Street 1:8700 S FREEPORT PKWY STE 100A
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-1920
Practice Address - Country:US
Practice Address - Phone:469-957-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63632183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist