=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396923561
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. JOSEPH ELISHA PARKER JR.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2008
-----------------------------------------------------
Last Update Date | 02/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 125 W COLLEGE AVE
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21804-6961
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-860-5813
-----------------------------------------------------
Fax | 410-860-5951
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4412 ISLAND VIEW RD
-----------------------------------------------------
City | SNOW HILL
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21863-4214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
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 | 08007
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | A1-0003058
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------