Healthcare Provider Details

I. General information

NPI: 1710849518
Provider Name (Legal Business Name): MADELINE CARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 BO BO DR
CRYSTAL SPRINGS MS
39059-2741
US

IV. Provider business mailing address

2444 PLEASANT HILL DR SE
BOGUE CHITTO MS
39629-4207
US

V. Phone/Fax

Practice location:
  • Phone: 601-892-4121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-102187
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: