Provider Demographics
NPI:1104132612
Name:PARKS, GLENDA FAYE (GLENDA PARKS)
Entity type:Individual
Prefix:MRS
First Name:GLENDA
Middle Name:FAYE
Last Name:PARKS
Suffix:
Gender:F
Credentials:GLENDA PARKS
Other - Prefix:MRS
Other - First Name:GLENDA
Other - Middle Name:
Other - Last Name:PARKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:GLENDA PARKS
Mailing Address - Street 1:6415 WACONDA POINT RD
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:TN
Mailing Address - Zip Code:37341-9580
Mailing Address - Country:US
Mailing Address - Phone:423-344-6068
Mailing Address - Fax:
Practice Address - Street 1:7354 E BRAINERD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3842
Practice Address - Country:US
Practice Address - Phone:423-899-2076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3517183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist