Provider Demographics
NPI:1649417080
Name:PARKER, THEODORE ROBERT (RPH, MPH)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:ROBERT
Last Name:PARKER
Suffix:
Gender:M
Credentials:RPH, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PMB 761 BOX 10003
Mailing Address - Street 2:
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950-8903
Mailing Address - Country:US
Mailing Address - Phone:670-233-2668
Mailing Address - Fax:670-233-2670
Practice Address - Street 1:101 AKARI BUILDING GUALO RAI
Practice Address - Street 2:CHALEN PALE ARNOLD ROAD
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950-8903
Practice Address - Country:US
Practice Address - Phone:670-233-2668
Practice Address - Fax:670-233-2670
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MP0007183500000X
WAPH00019323183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist