Provider Demographics
NPI:1902218670
Name:PARKER, NICHOLE LEIGH (RPH)
Entity Type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:LEIGH
Last Name:PARKER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4557 E THISTLE LANDING DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-6853
Mailing Address - Country:US
Mailing Address - Phone:602-214-8074
Mailing Address - Fax:
Practice Address - Street 1:5975 W CHANDLER BLVD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3422
Practice Address - Country:US
Practice Address - Phone:480-753-1827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS012797183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist