MEDICARE: MR. SHAN PARKER RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	T09117	MS
2	183500000X	Pharmacist	5692	WV
3	183500000X	Pharmacist	52261	CA
4	183500000X	Pharmacist	10184	TN

General Provider Information

NPI Number	:	1285921585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHAN PARKER RPH

Provider Business Mailing Address
First Line	:	650 HIGHWAY 100
Second Line	:
City	:	CENTERVILLE
State	:	TN
Zip	:	37033-1214
Country	:	US
Telephone Number	:	931-729-5005
Fax Number	:	931-729-2339

Provider Business Practice Location Address
First Line	:	650 HIGHWAY 100
Second Line	:
City	:	CENTERVILLE
State	:	TN
Zip	:	37033-1214
Country	:	US
Telephone Number	:	931-729-5005
Fax Number	:	931-729-2339

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2011
Last Update Date	:	12/21/2022

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Directions to “ MR. SHAN PARKER RPH” Practice Location

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