Provider Demographics
NPI:1215580535
Name:PARKS, ERICA LEE (PHARMD RPH)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:LEE
Last Name:PARKS
Suffix:
Gender:F
Credentials:PHARMD RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 FABYAN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH GROSVENORDALE
Mailing Address - State:CT
Mailing Address - Zip Code:06255-1525
Mailing Address - Country:US
Mailing Address - Phone:860-481-1117
Mailing Address - Fax:
Practice Address - Street 1:251 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1628
Practice Address - Country:US
Practice Address - Phone:860-928-1533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0014884183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist