Healthcare Provider Details

I. General information

NPI: 1093895435
Provider Name (Legal Business Name): CARTER PHARMACIST GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 09/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 JESSICA LANE, SUITE E
OLIVE HILL KY
41164
US

IV. Provider business mailing address

PO BOX 757
OLIVE HILL KY
41164-0757
US

V. Phone/Fax

Practice location:
  • Phone: 606-286-2029
  • Fax:
Mailing address:
  • Phone: 606-286-2029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberP06896
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. TOM MATTINGLY
Title or Position: PCI
Credential: RPH
Phone: 606-286-2029