Jeannie Park

NPI #1639760184 in Chantilly, Virginia

Provider Information

NPI Number: 1639760184
Entity Type: Individual
Name: Jeannie Park
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Pharmacist
Enumeration Date: Jan 28, 2021
Last Updated: Jan 28, 2021

Practice Location

Address: 13704 BLACK SPRUCE WAY
City: Chantilly
State: Virginia
ZIP Code: 20151-2345
Phone: (703) 475-4909

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pharmacist	183500000X	Primary

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