Provider Demographics
NPI:1740689876
Name:PARKS, CODIE L (PHARMD)
Entity type:Individual
Prefix:
First Name:CODIE
Middle Name:L
Last Name:PARKS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CODIE
Other - Middle Name:L
Other - Last Name:BONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:131 HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:KY
Mailing Address - Zip Code:42078
Mailing Address - Country:US
Mailing Address - Phone:270-988-7242
Mailing Address - Fax:
Practice Address - Street 1:131 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:KY
Practice Address - Zip Code:42078
Practice Address - Country:US
Practice Address - Phone:270-988-7242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY017085183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist