Provider Demographics
NPI:1285063933
Name:PARK, ESTHER JANE (PHARMD)
Entity type:Individual
Prefix:
First Name:ESTHER
Middle Name:JANE
Last Name:PARK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 METROPOLITAN AVE
Mailing Address - Street 2:#2
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3177
Mailing Address - Country:US
Mailing Address - Phone:704-973-3121
Mailing Address - Fax:
Practice Address - Street 1:900 METROPOLITAN AVE
Practice Address - Street 2:#2
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3177
Practice Address - Country:US
Practice Address - Phone:704-973-3121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23066183500000X
IN26022684A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist