Individual
MRS. KYU JA PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
50 IRVING ST NW, WASHINGTON, DC 20422-0001
(202) 745-8000
Mailing address
1550 MARY ELLEN CT, MCLEAN, VA 22101-5021
(703) 847-9726
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
030963-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
030963-1
PHARMACIST LICENSE
NY
01
—
10424
PHARMACIST LICENSE
MD
Enumeration date
10/12/2006
Last updated
07/08/2007
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