Healthcare Provider Details

I. General information

NPI: 1114925062
Provider Name (Legal Business Name): DAVID SETH CARTER PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 W BROADWAY ST
MUSKOGEE OK
74401-6246
US

IV. Provider business mailing address

1126 W BROADWAY ST
MUSKOGEE OK
74401-6246
US

V. Phone/Fax

Practice location:
  • Phone: 918-682-5584
  • Fax: 918-682-5585
Mailing address:
  • Phone: 918-682-5584
  • Fax: 918-682-5585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number13523
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: