Provider Demographics
NPI:1326182270
Name:OVERTON, CAROL SUE
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:SUE
Last Name:OVERTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 E LOCUST ST APT 6
Mailing Address - Street 2:
Mailing Address - City:FORT BRANCH
Mailing Address - State:IN
Mailing Address - Zip Code:47648-1456
Mailing Address - Country:US
Mailing Address - Phone:812-753-3138
Mailing Address - Fax:
Practice Address - Street 1:1325 W 9TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:IL
Practice Address - Zip Code:62863-2906
Practice Address - Country:US
Practice Address - Phone:618-263-4543
Practice Address - Fax:618-262-5294
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN67006005A183700000X
IL183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician