Healthcare Provider Details

I. General information

NPI: 1649417080
Provider Name (Legal Business Name): THEODORE ROBERT PARKER R.PH., MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2009
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 AKARI BUILDING GUALO RAI CHALEN PALE ARNOLD ROAD
SAIPAN MP
96950-8903
US

IV. Provider business mailing address

PMB 761 BOX 10003
SAIPAN MP
96950-8903
US

V. Phone/Fax

Practice location:
  • Phone: 670-233-2668
  • Fax: 670-233-2670
Mailing address:
  • Phone: 670-233-2668
  • Fax: 670-233-2670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0007
License Number StateMP
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00019323
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: