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Individual
MIN GEON PARK
Active
Individual
MIN GEON PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMACIST
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
019445
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
047855893
DRIVER LICENSE
GA
Enumeration date
11/05/2012
Last updated
11/05/2012
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