Healthcare Provider Details

I. General information

NPI: 1275645186
Provider Name (Legal Business Name): PARKER DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 QUITMAN ST
PITTSBURG TX
75686-1322
US

IV. Provider business mailing address

PO BOX 400
PITTSBURG TX
75686-0400
US

V. Phone/Fax

Practice location:
  • Phone: 903-856-3626
  • Fax: 903-856-5099
Mailing address:
  • Phone: 903-856-3626
  • Fax: 903-856-5099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number06334
License Number StateTX

VIII. Authorized Official

Name: STEPHEN PARKER
Title or Position: OWNER PRESIDENT
Credential:
Phone: 903-856-3626