Healthcare Provider Details

I. General information

NPI: 1710525563
Provider Name (Legal Business Name): KATHRYN TOHILL CARSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2019
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1829 HIGHWAY 45 N
COLUMBUS MS
39705-2152
US

IV. Provider business mailing address

417 4TH ST S
COLUMBUS MS
39701-6701
US

V. Phone/Fax

Practice location:
  • Phone: 662-327-9562
  • Fax:
Mailing address:
  • Phone: 859-619-7175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberE-010630
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: