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Provider Information for 1457539710


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PARKS PHARMACY

Other Names:  
Doing Business As: 
PARKS PHARMACY

Organization Subpart: NO

NPI: 1457539710
Last Updated: 2020-07-03
Certification Date: 2020-07-03

Details

NameValue
NPI1457539710
Enumeration Date2008-02-08
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: LA SONYA GLOVER
Title: President
Phone: 3347991489
Mailing Address PO BOX 250310
MONTGOMERY, AL 36125-0310
United States

Phone: 334-799-1489 | Fax:334-375-4723
 
Primary Practice Address 1323 MULBERRY ST STE A
MONTGOMERY, AL 36106-1545
United States

Phone: 334-264-1416 | Fax:334-264-1426
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)1996241PK
MEDICAIDAL100003578
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 333600000X - Pharmacy
Yes 332B00000X - Durable Medical Equipment & Medical Supplies AL113050