Provider Demographics
NPI:1154737252
Name:PARKS, STEVEN
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:PARKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-5013
Mailing Address - Country:US
Mailing Address - Phone:318-513-1260
Mailing Address - Fax:318-513-1266
Practice Address - Street 1:105 W CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-5013
Practice Address - Country:US
Practice Address - Phone:318-513-1260
Practice Address - Fax:318-513-1266
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020603183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist