Provider Demographics
NPI:1891879854
Name:PARKER ROAD DRUGS, INC
Entity Type:Organization
Organization Name:PARKER ROAD DRUGS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-419-8563
Mailing Address - Street 1:1319 WOODSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29611-3738
Mailing Address - Country:US
Mailing Address - Phone:864-232-4662
Mailing Address - Fax:843-271-5276
Practice Address - Street 1:1319 WOODSIDE AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611-3738
Practice Address - Country:US
Practice Address - Phone:864-232-4662
Practice Address - Fax:864-271-5276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
SC500026103336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4217724OtherOTHER ID NUMBER
SC726101Medicaid
SC0451820003Medicare NSC