Provider Demographics
NPI:1598195109
Name:PARKER, JERRY ROBERT (RPH)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:ROBERT
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 1:552 JUDACULLA ROCK RD
Mailing Address - Street 2:
Mailing Address - City:CULLOWHEE
Mailing Address - State:NC
Mailing Address - Zip Code:28723-8067
Mailing Address - Country:US
Mailing Address - Phone:828-371-0026
Mailing Address - Fax:
Practice Address - Street 1:552 JUDACULLA ROCK RD
Practice Address - Street 2:
Practice Address - City:CULLOWHEE
Practice Address - State:NC
Practice Address - Zip Code:28723-8067
Practice Address - Country:US
Practice Address - Phone:828-371-0026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC06053183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist