Provider Demographics
NPI:1043944721
Name:CARPENTER, GEREMY RENARD (BS, PHARMD, BCPS)
Entity Type:Individual
Prefix:DR
First Name:GEREMY
Middle Name:RENARD
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:BS, PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 DECATUR STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233
Mailing Address - Country:US
Mailing Address - Phone:190-123-8871
Mailing Address - Fax:
Practice Address - Street 1:388 DECATUR STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-1123
Practice Address - Country:US
Practice Address - Phone:901-238-8716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-10
Last Update Date:2022-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059772183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist