Healthcare Provider Details

I. General information

NPI: 1598679326
Provider Name (Legal Business Name): JAXON RYAN CARTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 OHARA ST
PITTSBURGH PA
15213-2561
US

IV. Provider business mailing address

116 N PACIFIC AVE
PITTSBURGH PA
15224-2441
US

V. Phone/Fax

Practice location:
  • Phone: 412-246-6347
  • Fax:
Mailing address:
  • Phone: 208-520-7032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License NumberRP460656
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: