Provider Demographics
NPI:1427466812
Name:PARK, ANA (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13550 PAXTON ST
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-2352
Mailing Address - Country:US
Mailing Address - Phone:818-272-2709
Mailing Address - Fax:818-272-2706
Practice Address - Street 1:13550 PAXTON ST
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-2352
Practice Address - Country:US
Practice Address - Phone:818-272-2709
Practice Address - Fax:818-272-2706
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2019-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70080183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist