Provider Demographics
NPI:1083219919
Name:PARRISH, CAROL DIANNE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:DIANNE
Last Name:PARRISH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-5433
Mailing Address - Country:US
Mailing Address - Phone:812-332-1419
Mailing Address - Fax:
Practice Address - Street 1:2701 E 3RD ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-5433
Practice Address - Country:US
Practice Address - Phone:812-332-1419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018643A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist