Shannon Park

Primary specialty

PharmacistTaxonomy code 183500000X

License

126345 Issued in MN

Practice address

2850 26TH Ave S
Minneapolis, MN 55406-4129

Phone

(612) 721-5840

Fax

(612) 721-2718

NPI assigned

Apr 30, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Supervalu Pharmacies Inc

  • Community/Retail Pharmacy
  • Minneapolis, MN
  • NPI 1497860530
  NPD (past)
• Supervalu Pharmacies Inc.

  • Community/Retail Pharmacy
  • Burnsville, MN
  • NPI 1093517914
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1714435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714435200000",
    "number": "1245087071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2211 E 24TH ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554044113",
            "telephone_number": "856-375-4406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2850 26TH AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554064129",
            "telephone_number": "612-721-5840",
            "fax_number": "612-721-2718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "SHANNON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-30",
        "last_updated": "2024-04-30",
        "certification_date": "2024-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MN",
            "license": "126345",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaila Park, LPCC
• Katharine Sippel Park, MD
• Meeock Park, PH. D.
• Michael Chankwon Park, M.D., PH.D.
• Paul Park
• Sue Young Park, M.D.
• Suhyun Park
• Ted Park
• Parkavenue Family Practice
• Caroline Louise Parke Portoghese, PT

• Pharmacist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Pharmacist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.