{
"Npi": {
"NPI": "1346527710",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "PARKS",
"FirstName": "MARK",
"MiddleName": "LANASA",
"NamePrefix": "MR.",
"NameSuffix": null,
"Credential": "CPHT",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5031 WAXHAW CROSSING DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WAXHAW",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28173-2400",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "704-616-9915",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "200 HAWTHORNE LN",
"SecondLinePracticeLocationAddress": "3RD FLOOR PHARMACY",
"PracticeLocationAddressCityName": "CHARLOTTE",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28204-2515",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "704-384-9480",
"PracticeLocationAddressFaxNumber": "704-316-4496",
"EnumerationDate": "11/13/2011",
"LastUpdateDate": "09/29/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "183700000X",
"TaxonomyName": "Pharmacy Technician",
"LicenseNumber": null,
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}