Min Geon Park, PHARMACIST

Primary specialty

PharmacistTaxonomy code 183500000X

License

019445 Issued in GA

Practice address

2420 Wisteria Dr
Snellville, GA 30078-6127

Phone

(770) 972-1592

NPI assigned

Nov 5, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1352073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352073600000",
    "number": "1780938308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4761 BANKSIDE WAY",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300925302",
            "telephone_number": "770-242-8961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2420 WISTERIA DR",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300786127",
            "telephone_number": "770-972-1592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "MIN",
        "middle_name": "GEON",
        "credential": "PHARMACIST",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-11-05",
        "last_updated": "2012-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "GA",
            "license": "019445",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVER LICENSE",
            "identifier": "047855893",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chasity Lucaroline Palmer, BS, RBT
• Angel J Paloade
• Paragon Emergency Physicians PC
• Paramount Csfa Group, LLC
• Sanjay Parikh, MD
• Sandra Park, MD, MS
• Parke Dixon Speech Factory
• Alliyah Parker, RBT
• Reneida Yvonne Parker, M.ED, CCC-SLP
• Parkway Dental

• Pharmacist in Snellville, GA
• Providers in Snellville, GA by specialty
• Pharmacist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2012; 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.