Healthcare Provider Details

I. General information

NPI: 1306763719
Provider Name (Legal Business Name): ABIGAIL SHANNON CARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 E MAIN ST
JACKSON OH
45640-2127
US

IV. Provider business mailing address

2646 SUGAR RUN RD
PIKETON OH
45661-9718
US

V. Phone/Fax

Practice location:
  • Phone: 740-286-6400
  • Fax: 740-286-4510
Mailing address:
  • Phone: 740-835-1417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03446800
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: