Provider Demographics
NPI:1528668704
Name:CARROLL, TERRY (RPH)
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:
Last Name:CARROLL
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 1:160 KINTER WAY
Mailing Address - Street 2:
Mailing Address - City:PEARISBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24134-2218
Mailing Address - Country:US
Mailing Address - Phone:540-921-2483
Mailing Address - Fax:
Practice Address - Street 1:160 KINTER WAY
Practice Address - Street 2:
Practice Address - City:PEARISBURG
Practice Address - State:VA
Practice Address - Zip Code:24134-2218
Practice Address - Country:US
Practice Address - Phone:540-921-2483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011365183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist