Provider Demographics
NPI:1790996742
Name:PARKER ROAD DRUGS, INC
Entity Type:Organization
Organization Name:PARKER ROAD DRUGS, INC
Other - Org Name:PARKER MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:PETRICH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:864-272-1001
Mailing Address - Street 1:23 MOHAWK DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-5726
Mailing Address - Country:US
Mailing Address - Phone:864-242-1101
Mailing Address - Fax:864-242-1330
Practice Address - Street 1:23 MOHAWK DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-5726
Practice Address - Country:US
Practice Address - Phone:864-242-1101
Practice Address - Fax:864-242-1330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDME458Medicaid
SC0451820001Medicare NSC