Provider Demographics
NPI:1720815483
Name:JUDKINS, PARKER (PHARMD, MBA)
Entity type:Individual
Prefix:DR
First Name:PARKER
Middle Name:
Last Name:JUDKINS
Suffix:
Gender:M
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13794 SE 136TH RD
Mailing Address - Street 2:
Mailing Address - City:WISTER
Mailing Address - State:OK
Mailing Address - Zip Code:74966-4021
Mailing Address - Country:US
Mailing Address - Phone:918-413-1004
Mailing Address - Fax:
Practice Address - Street 1:1 CHOCTAW WAY
Practice Address - Street 2:
Practice Address - City:TALIHINA
Practice Address - State:OK
Practice Address - Zip Code:74571-2022
Practice Address - Country:US
Practice Address - Phone:918-567-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20562183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist