Provider Demographics
NPI:1992706915
Name:CARLILE, JANICE WYNELL (RPH)
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:WYNELL
Last Name:CARLILE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:801 ARBOR FOREST CT SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-2868
Mailing Address - Country:US
Mailing Address - Phone:770-633-5917
Mailing Address - Fax:770-944-7702
Practice Address - Street 1:3875 AUSTELL RD
Practice Address - Street 2:SUITE 302
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1103
Practice Address - Country:US
Practice Address - Phone:770-944-9101
Practice Address - Fax:770-944-7702
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014647183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist