Healthcare Provider Details

I. General information

NPI: 1457539710
Provider Name (Legal Business Name): PARKS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 07/03/2020
Certification Date: 07/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 MULBERRY ST STE A
MONTGOMERY AL
36106-1545
US

IV. Provider business mailing address

PO BOX 250310
MONTGOMERY AL
36125-0310
US

V. Phone/Fax

Practice location:
  • Phone: 334-264-1416
  • Fax: 334-264-1426
Mailing address:
  • Phone: 334-799-1489
  • Fax: 334-375-4723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number113050
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: LA SONYA GLOVER
Title or Position: PRESIDENT
Credential:
Phone: 334-799-1489