Healthcare Provider Details

I. General information

NPI: 1316018740
Provider Name (Legal Business Name): LANA C CARTER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15268 US HIGHWAY 17
TOWNSEND GA
31331-3854
US

IV. Provider business mailing address

252 MELVIN WESTBERRY ROAD
JESUP GA
31545
US

V. Phone/Fax

Practice location:
  • Phone: 912-832-6194
  • Fax: 912-832-6677
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number018321
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: