MEDICARE: CARTERS PHARMACY INC

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PHRE007680	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2018671	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902974702
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARTERS PHARMACY INC

Provider Business Mailing Address
First Line	:	4704 AUGUSTA RD
Second Line	:
City	:	GARDEN CITY
State	:	GA
Zip	:	31408-1758
Country	:	US
Telephone Number	:	912-965-9911
Fax Number	:	912-965-1732

Provider Business Practice Location Address
First Line	:	4704 AUGUSTA RD
Second Line	:
City	:	GARDEN CITY
State	:	GA
Zip	:	31408-1758
Country	:	US
Telephone Number	:	912-965-9911
Fax Number	:	912-965-1732

Authorized Official
Title or Position	:	CEO
Name	:	AMY CARTER
Credential	:
Telephone Number	:	912-748-1414

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	05/05/2016

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