Provider Demographics
NPI:1275645186
Name:PARKER DRUG INC
Entity Type:Organization
Organization Name:PARKER DRUG INC
Other - Org Name:PARKER DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-856-3626
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:75686-0400
Mailing Address - Country:US
Mailing Address - Phone:903-856-3626
Mailing Address - Fax:903-856-5099
Practice Address - Street 1:114 QUITMAN ST
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:TX
Practice Address - Zip Code:75686-1322
Practice Address - Country:US
Practice Address - Phone:903-856-3626
Practice Address - Fax:903-856-5099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX063343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2098788OtherPK
TX142238Medicaid
2098788OtherPK