MEDICARE: JOHN W CARPENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	11181	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11181	OTHER	AL	PHARMACIST

General Provider Information

NPI Number	:	1134181050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN W CARPENTER

Provider Business Mailing Address
First Line	:	PO BOX 366
Second Line	:
City	:	HAYNEVILLE
State	:	AL
Zip	:	36040-0366
Country	:	US
Telephone Number	:	334-548-2125
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 LAFAYETTE ST
Second Line	:
City	:	HAYNEVILLE
State	:	AL
Zip	:	36040
Country	:	US
Telephone Number	:	334-548-2125
Fax Number	:	334-548-2126

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	08/27/2021

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Directions to “ JOHN W CARPENTER ” Practice Location

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