Provider Demographics
NPI:1730317520
Name:PARK, TAEHEE (PHARM D)
Entity type:Individual
Prefix:
First Name:TAEHEE
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 1:260 BERGEN TPKE
Mailing Address - Street 2:
Mailing Address - City:LITTLE FERRY
Mailing Address - State:NJ
Mailing Address - Zip Code:07643-1104
Mailing Address - Country:US
Mailing Address - Phone:201-870-6500
Mailing Address - Fax:
Practice Address - Street 1:260 BERGEN TPKE
Practice Address - Street 2:
Practice Address - City:LITTLE FERRY
Practice Address - State:NJ
Practice Address - Zip Code:07643-1104
Practice Address - Country:US
Practice Address - Phone:201-870-6500
Practice Address - Fax:201-870-6023
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03180200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI03180200OtherPHARMACIST