Provider Demographics
NPI:1659885911
Name:PARKS PHARMACY
Entity Type:Organization
Organization Name:PARKS PHARMACY
Other - Org Name:PARKS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-352-2198
Mailing Address - Street 1:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49083-0087
Mailing Address - Country:US
Mailing Address - Phone:269-352-2198
Mailing Address - Fax:
Practice Address - Street 1:318 S SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:MI
Practice Address - Zip Code:49224-1753
Practice Address - Country:US
Practice Address - Phone:517-629-9481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-24
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy