Provider Demographics
NPI:1285921585
Name:PARKER, SHAN (RPH)
Entity type:Individual
Prefix:MR
First Name:SHAN
Middle Name:
Last Name:PARKER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 HIGHWAY 100
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37033-1214
Mailing Address - Country:US
Mailing Address - Phone:931-729-5005
Mailing Address - Fax:931-729-2339
Practice Address - Street 1:650 HIGHWAY 100
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37033-1214
Practice Address - Country:US
Practice Address - Phone:931-729-5005
Practice Address - Fax:931-729-2339
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST09117183500000X
WV5692183500000X
CA52261183500000X
TN10184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist