Basic Information
Provider Information
NPI: 1811120348
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PARKINSON
FirstName: KURTIS
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential: RPH
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 860
Address2:  
City: WHITERIVER
State: AZ
PostalCode: 859410860
CountryCode: US
TelephoneNumber: 9283384911
FaxNumber:  
Practice Location
Address1: 200 WEST HOSPITAL DRIVE
Address2:  
City: WHITERIVER
State: AZ
PostalCode: 859410860
CountryCode: US
TelephoneNumber: 9283384911
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/01/2009
LastUpdateDate: 09/01/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X016449AZY Pharmacy Service ProvidersPharmacist 
183500000X0010474ORN Pharmacy Service ProvidersPharmacist 
183500000X00022175WAN Pharmacy Service ProvidersPharmacist 

No ID Information.


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