Provider Demographics
NPI:1366793705
Name:PARK, SHUL HYUNG (RPH)
Entity type:Individual
Prefix:
First Name:SHUL HYUNG
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544B GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-1863
Mailing Address - Country:US
Mailing Address - Phone:732-718-9838
Mailing Address - Fax:
Practice Address - Street 1:1400 ANDERSON AVE UNIT 7
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-4405
Practice Address - Country:US
Practice Address - Phone:201-224-8877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03514500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist