Provider Demographics
NPI:1336826296
Name:CARRUTH, COLLIN (PHARMD)
Entity type:Individual
Prefix:
First Name:COLLIN
Middle Name:
Last Name:CARRUTH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 BRIARCLIFF RD NE
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-2112
Mailing Address - Country:US
Mailing Address - Phone:205-431-7784
Mailing Address - Fax:
Practice Address - Street 1:1104 CULLMAN SHOPPING CTR NW
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-2855
Practice Address - Country:US
Practice Address - Phone:256-736-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23057183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist