Healthcare Provider Details

I. General information

NPI: 1366930307
Provider Name (Legal Business Name): JODI D PARKER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JODI D LINIGER

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 N MEADE ST
APPLETON WI
54911-3454
US

IV. Provider business mailing address

122 E COLLEGE AVE
APPLETON WI
54911-5794
US

V. Phone/Fax

Practice location:
  • Phone: 920-738-6520
  • Fax: 920-738-6339
Mailing address:
  • Phone: 920-996-3264
  • Fax: 920-830-5970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12346
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: