Active NPI
Jong-Beak Park, R.PH., PH.D.
- Pharmacist
- Marietta, GA
National Provider Identifier
1679717144
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302038479
- Practice address
- 3051 Sandy Plains Rd
Marietta, GA 30066-4721 - Phone
- (770) 977-7661
- NPI assigned
- Apr 28, 2009
- Last updated
- Sep 11, 2025
- Sex
- Male
- Sole proprietor
- Yes
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 | 5302038479 | MI | Primary |
Addresses
Primary practice location
3051 Sandy Plains Rd
Marietta, GA 30066-4721
Mailing address
3051 Sandy Plains Rd
Marietta, GA 30066-4721
Phone (770) 977-7661
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 Philosophy, Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302038479 | MI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Georgia CVS Pharmacy, L.L.C. | Past | Accepting new patients | |
| Georgia CVS Pharmacy L.L.C | Past | Accepting new patients | |
| Rite Aid of Michigan Inc | Past | Accepting new patients | |
| Rite Aid of Michigan Inc | Past | Accepting new patients |
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Rite Aid Pharmacy 04068
- Community/Retail Pharmacy
- Washington, MI
- NPI 1619117405
-
dba Rite Aid Pharmacy 01612
- Community/Retail Pharmacy
- Holt, MI
- NPI 1750490298
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1240876800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1679717144",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3051 SANDY PLAINS RD",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300664721",
"telephone_number": "770-977-7661"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3051 SANDY PLAINS RD",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300664721",
"telephone_number": "770-977-7661"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "JONG-BEAK",
"credential": "R.PH., PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-04-28",
"last_updated": "2025-09-11",
"certification_date": "2023-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302038479",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.