Provider Demographics
NPI:1457539710
Name:PARKS PHARMACY
Entity Type:Organization
Organization Name:PARKS PHARMACY
Other - Org Name:PARKS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LA SONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-799-1489
Mailing Address - Street 1:PO BOX 250310
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36125-0310
Mailing Address - Country:US
Mailing Address - Phone:334-799-1489
Mailing Address - Fax:334-375-4723
Practice Address - Street 1:1323 MULBERRY ST STE A
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1545
Practice Address - Country:US
Practice Address - Phone:334-264-1416
Practice Address - Fax:334-264-1426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL113050332B00000X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1996241OtherPK
AL100003578Medicaid