Provider Demographics
NPI:1568717593
Name:PARKS, CARIE RAE (PHARM D)
Entity Type:Individual
Prefix:
First Name:CARIE
Middle Name:RAE
Last Name:PARKS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 DEER RUN DR
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1356
Mailing Address - Country:US
Mailing Address - Phone:515-249-8059
Mailing Address - Fax:
Practice Address - Street 1:802 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-1525
Practice Address - Country:US
Practice Address - Phone:641-628-1612
Practice Address - Fax:641-620-0021
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051291334183500000X
IA18826183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist