Active NPI
Ellison Jinwoo Park, PHARMD
- Pharmacist
- Randallstown, MD
National Provider Identifier
1053904474
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 27818
- Practice address
- 9110 Liberty Rd
Randallstown, MD 21133-3522 - Phone
- (410) 496-8146
- NPI assigned
- Feb 17, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 27818 | MD | Primary |
Addresses
Primary practice location
9110 Liberty Rd
Randallstown, MD 21133-3522
Mailing address
3925 Beech Ave Apt 211
Baltimore, MD 21211-2254
Phone (860) 471-4005
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27818 | MD | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1613520000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613520000000",
"number": "1053904474",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3925 BEECH AVE APT 211",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212112254",
"telephone_number": "860-471-4005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9110 LIBERTY RD",
"city": "RANDALLSTOWN",
"state": "MD",
"postal_code": "211333522",
"telephone_number": "410-496-8146"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "ELLISON",
"middle_name": "JINWOO",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-02-17",
"last_updated": "2021-02-17",
"certification_date": "2021-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MD",
"license": "27818",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Randallstown, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.