Provider Demographics
NPI:1962226225
Name:PARKER, JONATHAN KYLE (PHARMD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:KYLE
Last Name:PARKER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 DEVERON CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-6232
Mailing Address - Country:US
Mailing Address - Phone:256-682-9406
Mailing Address - Fax:
Practice Address - Street 1:312 PALISADES BLVD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-5148
Practice Address - Country:US
Practice Address - Phone:205-520-5535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23786183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist