Provider Demographics
NPI:1366921066
Name:PARKER, ALIVIA CORA (PHARMD)
Entity type:Individual
Prefix:
First Name:ALIVIA
Middle Name:CORA
Last Name:PARKER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ALIVIA
Other - Middle Name:CORA
Other - Last Name:KUSIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 47
Mailing Address - Street 2:
Mailing Address - City:DERRICK CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16727-0047
Mailing Address - Country:US
Mailing Address - Phone:814-462-4383
Mailing Address - Fax:
Practice Address - Street 1:50 FOSTER BROOK BLVD
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-3276
Practice Address - Country:US
Practice Address - Phone:570-389-5755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2020-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP452389183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP452389OtherPHARMACIST LICENSE