Provider Demographics
NPI:1952441263
Name:PARKERS PHARMACY INC
Entity Type:Organization
Organization Name:PARKERS PHARMACY INC
Other - Org Name:PARKERS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANUJ
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHUKLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:7860-356-2826
Mailing Address - Street 1:102 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLTVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92250-1214
Mailing Address - Country:US
Mailing Address - Phone:760-356-2826
Mailing Address - Fax:760-356-3534
Practice Address - Street 1:102 W 5TH ST
Practice Address - Street 2:
Practice Address - City:HOLTVILLE
Practice Address - State:CA
Practice Address - Zip Code:92250-1214
Practice Address - Country:US
Practice Address - Phone:760-356-2826
Practice Address - Fax:760-356-3534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA555973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0533910Medicare UPIN