Provider Demographics
NPI:1215088687
Name:PARK, SANDY (PHARMACIST)
Entity type:Individual
Prefix:MRS
First Name:SANDY
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 OLD MILL RD
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3310
Mailing Address - Country:US
Mailing Address - Phone:516-698-1062
Mailing Address - Fax:
Practice Address - Street 1:62 OLD MILL RD
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3310
Practice Address - Country:US
Practice Address - Phone:516-627-3448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-14
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist