MEDICARE: MR. KEITH M CARSON PHARMD

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	RP439688	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RP439688	OTHER	PA	STATE LISCENSE

General Provider Information

NPI Number	:	1639468333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEITH M CARSON PHARMD

Provider Business Mailing Address
First Line	:	211 SWINNICK DR
Second Line	:
City	:	DUNMORE
State	:	PA
Zip	:	18512-2072
Country	:	US
Telephone Number	:	570-941-9440
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 N MAIN AVE
Second Line	:
City	:	SCRANTON
State	:	PA
Zip	:	18504-1866
Country	:	US
Telephone Number	:	570-342-6411
Fax Number	:

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

Provider Enumeration Date	:	04/04/2011
Last Update Date	:	04/04/2011

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