Provider Demographics
NPI:1609151596
Name:PARKHURST, MONICA LYNN (BPHARM, RPH)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:LYNN
Last Name:PARKHURST
Suffix:
Gender:F
Credentials:BPHARM, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54590 IRONWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1617
Mailing Address - Country:US
Mailing Address - Phone:574-968-3717
Mailing Address - Fax:574-314-6916
Practice Address - Street 1:54590 IRONWOOD RD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1617
Practice Address - Country:US
Practice Address - Phone:574-968-3717
Practice Address - Fax:574-314-6916
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017930A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26017930AOtherSTATE LICENSE