Provider Demographics
NPI:1194886473
Name:CARL, JOHN M (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:CARL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PINNARD ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-2836
Mailing Address - Country:US
Mailing Address - Phone:585-473-0207
Mailing Address - Fax:
Practice Address - Street 1:3 GEDDES STREET EXT
Practice Address - Street 2:
Practice Address - City:HOLLEY
Practice Address - State:NY
Practice Address - Zip Code:14470-1122
Practice Address - Country:US
Practice Address - Phone:585-638-5499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032166183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist