MEDICARE: KRISTA JERIANN PARKS PHARMD

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	RPH18799	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437757804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA JERIANN PARKS PHARMD

Provider Business Mailing Address
First Line	:	2700 BRASELTON HWY
Second Line	:
City	:	DACULA
State	:	GA
Zip	:	30019-3262
Country	:	US
Telephone Number	:	770-614-1022
Fax Number	:	770-614-4413

Provider Business Practice Location Address
First Line	:	2700 BRASELTON HWY
Second Line	:
City	:	DACULA
State	:	GA
Zip	:	30019-3262
Country	:	US
Telephone Number	:	770-614-1022
Fax Number	:	770-614-4413

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

Provider Enumeration Date	:	10/16/2020
Last Update Date	:	10/16/2020

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