Provider Demographics
NPI:1427330182
Name:CARR, ERIC PATRICK (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:PATRICK
Last Name:CARR
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 1:55 YUKON CIR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61705-8824
Mailing Address - Country:US
Mailing Address - Phone:847-867-5365
Mailing Address - Fax:
Practice Address - Street 1:505 W RAAB RD
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-1007
Practice Address - Country:US
Practice Address - Phone:309-454-7347
Practice Address - Fax:309-454-3915
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.292476183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL362127039410Medicaid