Provider Demographics
NPI:1245341551
Name:PARKER'S DRUG STORE, INC
Entity type:Organization
Organization Name:PARKER'S DRUG STORE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-837-2318
Mailing Address - Street 1:14 VALLEY RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:NC
Mailing Address - Zip Code:28906-2955
Mailing Address - Country:US
Mailing Address - Phone:828-837-2318
Mailing Address - Fax:828-837-5011
Practice Address - Street 1:14 VALLEY RIVER AVE
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-2955
Practice Address - Country:US
Practice Address - Phone:828-837-2318
Practice Address - Fax:828-837-5011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC004983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0205120Medicaid
NC1124150001Medicare ID - Type Unspecified