Provider Demographics
NPI:1699260828
Name:PARKERS PHARM DBA HIGHLAND HEIGHTS PHARMACY
Entity type:Organization
Organization Name:PARKERS PHARM DBA HIGHLAND HEIGHTS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:PARKER
Authorized Official - Last Name:TAGG
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:901-545-5817
Mailing Address - Street 1:1327 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-2325
Mailing Address - Country:US
Mailing Address - Phone:901-545-5817
Mailing Address - Fax:901-308-1784
Practice Address - Street 1:1327 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2325
Practice Address - Country:US
Practice Address - Phone:901-545-5817
Practice Address - Fax:901-308-1784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-29
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN7743336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ078662Medicaid
1699260828OtherNPI
TN774OtherPHARMACY LICENSE