Provider Demographics
NPI:1770646531
Name:PARKER, MIRAL H (DPH)
Entity Type:Individual
Prefix:DR
First Name:MIRAL
Middle Name:H
Last Name:PARKER
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 S PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73119-4945
Mailing Address - Country:US
Mailing Address - Phone:405-682-4423
Mailing Address - Fax:405-682-4462
Practice Address - Street 1:4901 S PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73119-4945
Practice Address - Country:US
Practice Address - Phone:405-682-4423
Practice Address - Fax:405-682-4462
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8619183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist