Provider Demographics
NPI:1285942144
Name:CARROLL, DAVID ALLEN (DOCTOR OF PHARMACY)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALLEN
Last Name:CARROLL
Suffix:
Gender:M
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 PICKWICK STREET
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372
Mailing Address - Country:US
Mailing Address - Phone:731-925-5551
Mailing Address - Fax:731-925-5724
Practice Address - Street 1:835 PICKWICK STREET
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372
Practice Address - Country:US
Practice Address - Phone:731-925-5551
Practice Address - Fax:731-925-5724
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33088183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1811373491OtherPHARMACY