Provider Demographics
NPI:1053647255
Name:CARROLL PHARMACY INC
Entity Type:Organization
Organization Name:CARROLL PHARMACY INC
Other - Org Name:CARROLL PHARMACY LONG TERM CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:JORDAN
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:919-934-7164
Mailing Address - Street 1:840 S BRIGHTLEAF BLVD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-4377
Mailing Address - Country:US
Mailing Address - Phone:919-934-7164
Mailing Address - Fax:919-934-0921
Practice Address - Street 1:840 S BRIGHTLEAF BLVD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4377
Practice Address - Country:US
Practice Address - Phone:919-934-7164
Practice Address - Fax:919-934-0921
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARROLL PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-22
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC033263336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0515296Medicaid
NC7700865Medicaid
NC1078450001Medicare NSC