Individual
JEANNIE PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13704 BLACK SPRUCE WAY, CHANTILLY, VA 20151-2345
(703) 475-4909
Mailing address
13704 BLACK SPRUCE WAY, CHANTILLY, VA 20151-2345
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0202212346
VA
Other
Enumeration date
01/28/2021
Last updated
01/28/2021
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