Provider Demographics
NPI:1790120665
Name:PARKS, CHARLES DAVIS (RPH)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:DAVIS
Last Name:PARKS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2633 MCKINNEY AVE # 130-240
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2581
Mailing Address - Country:US
Mailing Address - Phone:214-394-8644
Mailing Address - Fax:214-206-9073
Practice Address - Street 1:2603 OAK LAWN AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4021
Practice Address - Country:US
Practice Address - Phone:214-394-8644
Practice Address - Fax:214-206-9073
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25396183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist