Provider Demographics
NPI:1508134677
Name:PARKS, CEDRICK D (RPH)
Entity Type:Individual
Prefix:MR
First Name:CEDRICK
Middle Name:D
Last Name:PARKS
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 1:7201 WENTWORTH WAY
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45315-8994
Mailing Address - Country:US
Mailing Address - Phone:937-287-8296
Mailing Address - Fax:937-854-9496
Practice Address - Street 1:5371 SALEM AVE
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426
Practice Address - Country:US
Practice Address - Phone:937-854-8829
Practice Address - Fax:937-854-9496
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-19272183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist