Healthcare Provider Details

I. General information

NPI: 1154599355
Provider Name (Legal Business Name): PARKS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 04/03/2014
Certification Date:
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: 877-827-1288
Mailing address:
  • Phone: 334-264-1416
  • Fax: 877-827-1288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number113050
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DEE PARKS
Title or Position: PRESIDENT
Credential: RPH
Phone: 877-827-1288