Healthcare Provider Details

I. General information

NPI: 1245384585
Provider Name (Legal Business Name): CLINTON JOSEPH CARR PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 N ELM ST
HENDERSON KY
42420-2783
US

IV. Provider business mailing address

119 W 22ND ST
OWENSBORO KY
42303-5112
US

V. Phone/Fax

Practice location:
  • Phone: 270-827-7164
  • Fax: 270-830-4711
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number008641
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: