Healthcare Provider Details

I. General information

NPI: 1134181050
Provider Name (Legal Business Name): JOHN W CARPENTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 08/27/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 LAFAYETTE ST
HAYNEVILLE AL
36040
US

IV. Provider business mailing address

PO BOX 366
HAYNEVILLE AL
36040-0366
US

V. Phone/Fax

Practice location:
  • Phone: 334-548-2125
  • Fax: 334-548-2126
Mailing address:
  • Phone: 334-548-2125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11181
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: