Provider Demographics
NPI:1922206242
Name:PARKS, TARA A (PHARMD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:A
Last Name:PARKS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-2309
Mailing Address - Country:US
Mailing Address - Phone:509-684-8481
Mailing Address - Fax:509-684-3275
Practice Address - Street 1:391 N MAIN ST
Practice Address - Street 2:
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-2309
Practice Address - Country:US
Practice Address - Phone:509-684-8481
Practice Address - Fax:509-684-3275
Is Sole Proprietor?:No
Enumeration Date:2007-07-08
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58965183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist