MEDICARE: DR. MISTY MAREE CARROLL PHARM. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	013664	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	013664	OTHER	KY	KENTUCKY BOARD OF PHARMAC

General Provider Information

NPI Number	:	1619175866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MISTY MAREE CARROLL PHARM. D.

Provider Business Mailing Address
First Line	:	312 S MAIN ST
Second Line	:
City	:	HARTFORD
State	:	KY
Zip	:	42347-1129
Country	:	US
Telephone Number	:	270-298-3279
Fax Number	:	270-298-3278

Provider Business Practice Location Address
First Line	:	312 S MAIN ST
Second Line	:
City	:	HARTFORD
State	:	KY
Zip	:	42347-1129
Country	:	US
Telephone Number	:	270-298-3279
Fax Number	:	270-298-3278

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2007
Last Update Date	:	07/10/2007

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