Provider Demographics
NPI:1215651609
Name:PARK, EUGENE HOON (PHARMD)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:HOON
Last Name:PARK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 VISTA DEL AMIGO
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-4650
Mailing Address - Country:US
Mailing Address - Phone:949-400-1713
Mailing Address - Fax:
Practice Address - Street 1:27310 BASELINE ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-3252
Practice Address - Country:US
Practice Address - Phone:909-862-4048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist