Provider Demographics
NPI:1932229358
Name:PARK, JI HEE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JI
Middle Name:HEE
Last Name:PARK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:PO BOX 32861
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28232-2861
Mailing Address - Country:US
Mailing Address - Phone:704-446-1405
Mailing Address - Fax:
Practice Address - Street 1:1350 S KINGS DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-2134
Practice Address - Country:US
Practice Address - Phone:704-446-1400
Practice Address - Fax:704-446-1410
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17231183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist