Active NPI
Shane Matthew Parks
- Pharmacist
- Medina, OH
National Provider Identifier
1407574429
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 03334873
- Practice address
- 1015 N Court St
Medina, OH 44256-1582 - Phone
- (330) 725-2706
- NPI assigned
- Aug 16, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 03334873 | OH | Primary |
Addresses
Primary practice location
1015 N Court St
Medina, OH 44256-1582
Mailing address
7009 Hawthorn Trce
Independence, OH 44131-5353
Phone (330) 718-3521
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 03334873 | OH | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1660608000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660608000000",
"number": "1407574429",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7009 HAWTHORN TRCE",
"city": "INDEPENDENCE",
"state": "OH",
"postal_code": "441315353",
"telephone_number": "330-718-3521"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1015 N COURT ST",
"city": "MEDINA",
"state": "OH",
"postal_code": "442561582",
"telephone_number": "330-725-2706"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARKS",
"first_name": "SHANE",
"middle_name": "MATTHEW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-08-16",
"last_updated": "2022-08-16",
"certification_date": "2022-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OH",
"license": "03334873",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medina, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.