Provider Demographics
NPI:1598443715
Name:PARKS, EVAN BRIAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:BRIAN
Last Name:PARKS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 W WEDINGTON DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-5733
Mailing Address - Country:US
Mailing Address - Phone:479-442-2561
Mailing Address - Fax:479-442-2842
Practice Address - Street 1:4015 W WEDINGTON DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-5733
Practice Address - Country:US
Practice Address - Phone:479-442-2561
Practice Address - Fax:479-442-2842
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD16642183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist