MEDICARE: LAUREN ALEXANDRA CARROLL PHARM. D

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	PD11382	AR

General Provider Information

NPI Number	:	1235907924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN ALEXANDRA CARROLL PHARM. D

Provider Business Mailing Address
First Line	:	154 GARNER MOUNTAIN RD
Second Line	:
City	:	AMITY
State	:	AR
Zip	:	71921-9014
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	744 HIGHWAY 270 E
Second Line	:
City	:	MOUNT IDA
State	:	AR
Zip	:	71957-8003
Country	:	US
Telephone Number	:	870-867-3174
Fax Number	:

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

Provider Enumeration Date	:	12/13/2023
Last Update Date	:	12/13/2023

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