Provider Demographics
NPI:1154599355
Name:PARKS PHARMACY INC
Entity type:Organization
Organization Name:PARKS PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:877-827-1288
Mailing Address - Street 1:PO BOX 250310
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36125-0310
Mailing Address - Country:US
Mailing Address - Phone:334-264-1416
Mailing Address - Fax:877-827-1288
Practice Address - Street 1:1323 MULBERRY ST STE A
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1545
Practice Address - Country:US
Practice Address - Phone:334-264-1416
Practice Address - Fax:877-827-1288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1130503336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1996244OtherPK
AL7021550001Medicare NSC