Provider Demographics
NPI:1619047032
Name:PARKER, WANDA JANE
Entity Type:Individual
Prefix:MS
First Name:WANDA
Middle Name:JANE
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6209 SUNNYSIDE RD
Mailing Address - Street 2:P.O. BOX 206
Mailing Address - City:CAPE CHARLES
Mailing Address - State:VA
Mailing Address - Zip Code:23310
Mailing Address - Country:US
Mailing Address - Phone:757-331-1780
Mailing Address - Fax:
Practice Address - Street 1:6209 SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:CAPE CHARLES
Practice Address - State:VA
Practice Address - Zip Code:23310
Practice Address - Country:US
Practice Address - Phone:757-331-1780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230008781183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician