Provider Demographics
NPI:1508513318
Name:PARKER, AMANDA (RPH)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3999 COUNTY ROAD 560
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-2508
Mailing Address - Country:US
Mailing Address - Phone:325-998-0940
Mailing Address - Fax:
Practice Address - Street 1:1870B STATE HIGHWAY 36 W
Practice Address - Street 2:
Practice Address - City:RISING STAR
Practice Address - State:TX
Practice Address - Zip Code:76471-3454
Practice Address - Country:US
Practice Address - Phone:254-643-3231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38759183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist