Provider Demographics
NPI:1477839199
Name:PARR, NATALIE J
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:J
Last Name:PARR
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 OAKSHIRE DR E
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-8529
Mailing Address - Country:US
Mailing Address - Phone:618-593-9526
Mailing Address - Fax:
Practice Address - Street 1:105 OAKSHIRE DR E
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-8529
Practice Address - Country:US
Practice Address - Phone:618-593-9526
Practice Address - Fax:
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
IL051.289898183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist