Healthcare Provider Details

I. General information

NPI: 1598870537
Provider Name (Legal Business Name): MALCOLM R. PARKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 TURIN RD
LOWVILLE NY
13367-1721
US

IV. Provider business mailing address

7400 TURIN RD
LOWVILLE NY
13367-1721
US

V. Phone/Fax

Practice location:
  • Phone: 315-376-4212
  • Fax: 315-376-4366
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number020243
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MALCOLM PARKS
Title or Position: OWNER PHARMACIST
Credential: RPH
Phone: 315-376-4212