Provider Demographics
NPI:1851781330
Name:PARKER, KAYANNA
Entity Type:Individual
Prefix:
First Name:KAYANNA
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 RALEIGH ROAD PKWY W
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-8218
Mailing Address - Country:US
Mailing Address - Phone:252-265-4501
Mailing Address - Fax:252-265-4511
Practice Address - Street 1:3401 RALEIGH ROAD PKWY W
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-8218
Practice Address - Country:US
Practice Address - Phone:252-265-4501
Practice Address - Fax:252-265-4511
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36535183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician