Provider Demographics
NPI:1932362308
Name:PARK, SUEJIN (PHARM D)
Entity Type:Individual
Prefix:
First Name:SUEJIN
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4054 7TH AVE NE APT 1
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-6479
Mailing Address - Country:US
Mailing Address - Phone:206-240-9518
Mailing Address - Fax:
Practice Address - Street 1:2700 NE UNIVERSITY VILLAGE ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-5016
Practice Address - Country:US
Practice Address - Phone:206-525-0705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP600015322183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist