Provider Demographics
NPI:1770967374
Name:PARKS, JAQUELINE (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:JAQUELINE
Middle Name:
Last Name:PARKS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:MISS
Other - First Name:JAQUELINE
Other - Middle Name:
Other - Last Name:STERLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 BONIETA HARROLD DR
Mailing Address - Street 2:APT 11102
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5157
Mailing Address - Country:US
Mailing Address - Phone:843-571-6567
Mailing Address - Fax:
Practice Address - Street 1:2566 ASHLEY RIVER RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-4605
Practice Address - Country:US
Practice Address - Phone:843-571-6567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36206183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist