Provider Demographics
NPI:1679709455
Name:PARKER, KELLI J (RPH)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:J
Last Name:PARKER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 W END AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1710
Mailing Address - Country:US
Mailing Address - Phone:615-321-4505
Mailing Address - Fax:615-321-0587
Practice Address - Street 1:2416 W END AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1710
Practice Address - Country:US
Practice Address - Phone:615-321-4505
Practice Address - Fax:615-321-0587
Is Sole Proprietor?:No
Enumeration Date:2009-06-06
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10355183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1619123569Medicaid