Provider Demographics
NPI:1033731278
Name:CARROLL, SETH (PHARMD)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:CARROLL
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 1:801 LANDSDOWNE AVE
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:KY
Mailing Address - Zip Code:41143-2110
Mailing Address - Country:US
Mailing Address - Phone:606-315-3865
Mailing Address - Fax:
Practice Address - Street 1:LEWIS COUNTY PRIMARY CARE CENTER
Practice Address - Street 2:211 KY 59
Practice Address - City:VANCEBURG
Practice Address - State:KY
Practice Address - Zip Code:41179
Practice Address - Country:US
Practice Address - Phone:606-796-2686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03439492183500000X
KY015446183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist