Provider Demographics
NPI:1699846212
Name:PARKSIDE PHARMACY
Entity Type:Organization
Organization Name:PARKSIDE PHARMACY
Other - Org Name:PARKSIDE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-712-0649
Mailing Address - Street 1:6449 COIT RD STE 116
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-8670
Mailing Address - Country:US
Mailing Address - Phone:972-712-0649
Mailing Address - Fax:972-712-0644
Practice Address - Street 1:6449 COIT RD STE 116
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-8670
Practice Address - Country:US
Practice Address - Phone:972-712-0649
Practice Address - Fax:972-712-0644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX294913336C0003X
333600000X, 3336C0004X, 3336M0002X
TX195883336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2152005OtherPK
4509393OtherNCPDP PROVIDER IDENTIFICATION NUMBER