Healthcare Provider Details

I. General information

NPI: 1902903792
Provider Name (Legal Business Name): JESSICA D PARKER PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 PERRY HILL RD
MONTGOMERY AL
36109-3725
US

IV. Provider business mailing address

1824 RADCLIFFE RD
MONTGOMERY AL
36106-2715
US

V. Phone/Fax

Practice location:
  • Phone: 334-272-4670
  • Fax: 334-260-4133
Mailing address:
  • Phone: 334-279-4925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number13547
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: