Provider Demographics
NPI:1629518188
Name:PARKER, BECKY
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:
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:PO BOX 180
Mailing Address - Street 2:
Mailing Address - City:CROWVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71230-0180
Mailing Address - Country:US
Mailing Address - Phone:318-376-4929
Mailing Address - Fax:
Practice Address - Street 1:2106 LOOP RD
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-3344
Practice Address - Country:US
Practice Address - Phone:318-435-9411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.016142183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist