Provider Demographics
NPI:1033408034
Name:CARROLL, JOHN THOMAS JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:THOMAS
Last Name:CARROLL
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1085 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1919
Mailing Address - Country:US
Mailing Address - Phone:770-614-2880
Mailing Address - Fax:770-614-2884
Practice Address - Street 1:1085 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1919
Practice Address - Country:US
Practice Address - Phone:770-614-2880
Practice Address - Fax:770-614-2884
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH012681183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist