Healthcare Provider Details

I. General information

NPI: 1902808330
Provider Name (Legal Business Name): PAMELA DEAN PARKS R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PARK BLVD
BRISTOL TN
37620-7450
US

IV. Provider business mailing address

323 THOMAS BRIDGE RD
MARION VA
24354-6462
US

V. Phone/Fax

Practice location:
  • Phone: 423-844-2888
  • Fax:
Mailing address:
  • Phone: 276-782-9061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0000010702
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: