=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366921066
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALIVIA CORA PARKER PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2018
-----------------------------------------------------
Last Update Date | 03/28/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 FOSTER BROOK BLVD
-----------------------------------------------------
City | BRADFORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16701-3276
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-389-5755
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 47
-----------------------------------------------------
City | DERRICK CITY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16727-0047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-462-4383
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP452389
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------