Provider Demographics
NPI:1457674913
Name:PARKER, ELISABETH MARY
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:MARY
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 WINNERS WAY
Mailing Address - Street 2:
Mailing Address - City:WARNERS
Mailing Address - State:NY
Mailing Address - Zip Code:13164-9051
Mailing Address - Country:US
Mailing Address - Phone:315-254-6161
Mailing Address - Fax:
Practice Address - Street 1:104 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-2555
Practice Address - Country:US
Practice Address - Phone:315-492-0248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052167-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist