Healthcare Provider Details

I. General information

NPI: 1154539328
Provider Name (Legal Business Name): JOSEPH FORD CARPENTER R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 PINE GROVE AVE
PORT HURON MI
48060-1976
US

IV. Provider business mailing address

3129 CONGER ST
PORT HURON MI
48060-2276
US

V. Phone/Fax

Practice location:
  • Phone: 810-987-3663
  • Fax: 810-987-1411
Mailing address:
  • Phone: 810-987-2774
  • Fax: 810-987-1311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302020854
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: