Provider Demographics
NPI:1114969417
Name:PARKER DRUG COMPANY INC
Entity Type:Organization
Organization Name:PARKER DRUG COMPANY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CANADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-562-3333
Mailing Address - Street 1:PO BOX 617
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:VA
Mailing Address - Zip Code:23851-0617
Mailing Address - Country:US
Mailing Address - Phone:757-562-3333
Mailing Address - Fax:757-562-7620
Practice Address - Street 1:102 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851-1752
Practice Address - Country:US
Practice Address - Phone:757-562-3333
Practice Address - Fax:757-562-7620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201002758332B00000X, 333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009143530OtherMEDICAID DME
4824846OtherOTHER ID NUMBER-COMMERCIAL NUMBER
VA8530521Medicaid
0193750001Medicare ID - Type Unspecified