Provider Demographics
NPI:1033491071
Name:CARVER, PHILLIP JONAS (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:JONAS
Last Name:CARVER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545-1171
Mailing Address - Country:US
Mailing Address - Phone:912-588-1035
Mailing Address - Fax:912-588-7016
Practice Address - Street 1:102 S 1ST ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-1171
Practice Address - Country:US
Practice Address - Phone:912-588-1035
Practice Address - Fax:912-588-7016
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH22968183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist