Healthcare Provider Details

I. General information

NPI: 1669353199
Provider Name (Legal Business Name): DESTINY CARROLL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14543 GLOBAL PKWY STE 100
FORT MYERS FL
33913-9446
US

IV. Provider business mailing address

14543 GLOBAL PKWY
FORT MYERS FL
33913-7225
US

V. Phone/Fax

Practice location:
  • Phone: 904-309-4655
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number69486
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: