=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699260828
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARKERS PHARM DBA HIGHLAND HEIGHTS PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2018
-----------------------------------------------------
Last Update Date | 01/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1327 MADISON AVE
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38104-2325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-545-5817
-----------------------------------------------------
Fax | 901-308-1784
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1327 MADISON AVE
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38104-2325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-545-5817
-----------------------------------------------------
Fax | 901-308-1784
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST IN CHARGE/OWNER
-----------------------------------------------------
Name | SUZANNE PARKER TAGG
-----------------------------------------------------
Credential | DPH
-----------------------------------------------------
Telephone | 901-545-5817
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 774
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------