Provider Demographics
NPI:1063023646
Name:PENTLAND, CARALYN HAYLEY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CARALYN
Middle Name:HAYLEY
Last Name:PENTLAND
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4433 DOUGLAS RD
Mailing Address - Street 2:
Mailing Address - City:MILLSTADT
Mailing Address - State:IL
Mailing Address - Zip Code:62260-2720
Mailing Address - Country:US
Mailing Address - Phone:618-971-3057
Mailing Address - Fax:
Practice Address - Street 1:4433 DOUGLAS RD
Practice Address - Street 2:
Practice Address - City:MILLSTADT
Practice Address - State:IL
Practice Address - Zip Code:62260-2720
Practice Address - Country:US
Practice Address - Phone:618-971-3057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-16
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29470183500000X
MO2020017438183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist