Provider Demographics
NPI:1215259148
Name:PARKS, COLLEEN ANN (RPH)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:ANN
Last Name:PARKS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:COLLEEN
Other - Middle Name:ANN
Other - Last Name:CURRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:2024 HIGHWAY 2 EAST
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901
Mailing Address - Country:US
Mailing Address - Phone:406-257-5454
Mailing Address - Fax:406-756-0192
Practice Address - Street 1:2024 HIGHWAY 2 EAST
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901
Practice Address - Country:US
Practice Address - Phone:406-257-5454
Practice Address - Fax:406-756-0192
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3075183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist