Provider Demographics
NPI:1477650828
Name:PARKER'S DRUG STORE, INC
Entity Type:Organization
Organization Name:PARKER'S DRUG STORE, INC
Other - Org Name:PARKER'S OF PEACHTREE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-837-4145
Mailing Address - Street 1:4278 E US HIGHWAY 64 ALT
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:NC
Mailing Address - Zip Code:28906-6846
Mailing Address - Country:US
Mailing Address - Phone:828-837-4145
Mailing Address - Fax:828-837-4675
Practice Address - Street 1:4278 E US HIGHWAY 64 ALT
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-6846
Practice Address - Country:US
Practice Address - Phone:828-837-4145
Practice Address - Fax:828-837-4675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC060393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC06039OtherPHARMACY PERMIT
NC0205237Medicaid
NC0205237Medicaid
NC06039OtherPHARMACY PERMIT
NC1124150002Medicare ID - Type Unspecified