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General NPI Number Information
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NPI Number | 1912507435
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Entity Type | Individual
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Provider Name | SHAWNDRA LEA PARKS I RPHD
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Gender | Female
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Dates
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Enumeration Date | 10/26/2020
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Last Update Date | 10/26/2020
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Provider Practice Location Address
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Address Line | 804 PIKE ST
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City | MARIETTA
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State | OH
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Zip | 45750-3503
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Country | US
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Telephone | 740-376-9035
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Fax |
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Provider Business Mailing Address
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Address Line | 804 PIKE ST
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City | MARIETTA
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State | OH
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Zip | 45750-3503
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Country | US
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Telephone | 740-376-9035
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 17090
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 27181
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License Number State | OH
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