Provider Demographics
NPI:1477839140
Name:PARKER, BRIAN L (RPH)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:L
Last Name:PARKER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 WILEYS CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-5440
Mailing Address - Country:US
Mailing Address - Phone:502-749-2885
Mailing Address - Fax:
Practice Address - Street 1:3980 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-4144
Practice Address - Country:US
Practice Address - Phone:502-447-4232
Practice Address - Fax:502-447-5796
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10881183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist