Provider Demographics
NPI:1073679171
Name:PARKS DRUG
Entity Type:Organization
Organization Name:PARKS DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:R.PH., OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:G
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:405-382-3870
Mailing Address - Street 1:PO BOX 30
Mailing Address - Street 2:330 NORTH MAIN STREET
Mailing Address - City:SEMINOLE
Mailing Address - State:OK
Mailing Address - Zip Code:74818-0030
Mailing Address - Country:US
Mailing Address - Phone:405-382-3870
Mailing Address - Fax:405-382-3872
Practice Address - Street 1:330 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:OK
Practice Address - Zip Code:74868-3428
Practice Address - Country:US
Practice Address - Phone:405-382-3870
Practice Address - Fax:405-382-3872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK245623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy