Provider Demographics
NPI:1750450961
Name:PARKER PHARMACY, LLC
Entity Type:Organization
Organization Name:PARKER PHARMACY, LLC
Other - Org Name:PARKER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PONCELET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-630-0908
Mailing Address - Street 1:PO BOX 519
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:SD
Mailing Address - Zip Code:57053-0519
Mailing Address - Country:US
Mailing Address - Phone:605-297-3235
Mailing Address - Fax:605-297-5594
Practice Address - Street 1:27516 SD HIGHWAY 19 STE 2
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:SD
Practice Address - Zip Code:57053-5633
Practice Address - Country:US
Practice Address - Phone:605-297-3235
Practice Address - Fax:605-297-5594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD100-19793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4300365OtherNCPDP PROVIDER IDENTIFICATION NUMBER
SD6727520001Medicare NSC