Healthcare Provider Details

I. General information

NPI: 1073117156
Provider Name (Legal Business Name): ANCIL CARRUTHERS III PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 CAPITAL CIR NE
TALLAHASSEE FL
32308-4598
US

IV. Provider business mailing address

1875 CAPITAL CIR NE # ME
TALLAHASSEE FL
32308-4598
US

V. Phone/Fax

Practice location:
  • Phone: 850-216-2244
  • Fax:
Mailing address:
  • Phone: 850-216-2244
  • Fax: 850-216-1675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPS47816
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: