1053579342 NPI number — DR. MARY HERRING PARKER PHARMD

Table of content: DR. MARY HERRING PARKER PHARMD (NPI 1053579342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053579342 NPI number — DR. MARY HERRING PARKER PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARKER
Provider First Name:
MARY
Provider Middle Name:
HERRING
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053579342
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1126 NORTH CHURCH STREET
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27401-1037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-547-1752
Provider Business Mailing Address Fax Number:
336-547-1812

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1126 N CHURCH ST
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27401-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-547-1752
Provider Business Practice Location Address Fax Number:
336-547-1812
Provider Enumeration Date:
05/23/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835P0018X , with the licence number:  14363 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1835P1200X , with the licence number: 700053 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 14363 . This is a "NC PHARMACY BOARD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 700053 . This is a "NC MEDICAL BOARD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".