Individual
JONG PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4901 SPRING ST, MOUNT PLEASANT, WI 53406-2901
(262) 886-9643
Mailing address
4901 SPRING ST, MOUNT PLEASANT, WI 53406-2901
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
051300909
IL
183500000X
Pharmacist
Primary
19030-40
WI
Other
Enumeration date
02/22/2020
Last updated
02/22/2020
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