Provider Demographics
NPI:1609156157
Name:PARKS, NIKKIA MONIQUE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NIKKIA
Middle Name:MONIQUE
Last Name:PARKS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 SUTHERLAND DR SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-4985
Mailing Address - Country:US
Mailing Address - Phone:616-827-2912
Mailing Address - Fax:
Practice Address - Street 1:1820 SUTHERLAND DR SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508-4985
Practice Address - Country:US
Practice Address - Phone:616-827-2912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-27
Last Update Date:2011-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302033731183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist