Provider Demographics
NPI:1659621845
Name:PARKO INC
Entity Type:Organization
Organization Name:PARKO INC
Other - Org Name:MAC PRESCRIPTION SHOP AT PMC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WINNEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:503-472-2146
Mailing Address - Street 1:2435 NE CUMULUS AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-8805
Mailing Address - Country:US
Mailing Address - Phone:503-472-2148
Mailing Address - Fax:971-261-2263
Practice Address - Street 1:2435 NE CUMULUS AVE STE C
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-8805
Practice Address - Country:US
Practice Address - Phone:503-472-2148
Practice Address - Fax:971-261-2263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
ORRP00027453336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2137484OtherPK