MEDICARE: MR. MICHAEL WILLIAM PARKER RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS23243	ZZ

General Provider Information

NPI Number	:	1104106764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL WILLIAM PARKER RPH

Provider Business Mailing Address
First Line	:	1756 HEATHERWOOD DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32259-5227
Country	:	US
Telephone Number	:	904-287-8016
Fax Number	:	904-287-8442

Provider Business Practice Location Address
First Line	:	2839 COUNTY ROAD 210 W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32259-2016
Country	:	US
Telephone Number	:	904-287-5476
Fax Number	:	904-287-8442

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2011
Last Update Date	:	08/26/2011

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