Provider Demographics
NPI:1912532813
Name:PARDA, PHILIP A (PHARMD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:A
Last Name:PARDA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8615 N PORT WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:FOX POINT
Mailing Address - State:WI
Mailing Address - Zip Code:53217-2202
Mailing Address - Country:US
Mailing Address - Phone:414-352-0526
Mailing Address - Fax:414-352-2149
Practice Address - Street 1:8615 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:FOX POINT
Practice Address - State:WI
Practice Address - Zip Code:53217-2202
Practice Address - Country:US
Practice Address - Phone:414-352-0526
Practice Address - Fax:414-352-2149
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19014-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist