Provider Demographics
NPI:1073117156
Name:CARRUTHERS, ANCIL III (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANCIL
Middle Name:
Last Name:CARRUTHERS
Suffix:III
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 1:1875 CAPITAL CIR NE # ME
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4598
Mailing Address - Country:US
Mailing Address - Phone:850-216-2244
Mailing Address - Fax:850-216-1675
Practice Address - Street 1:1875 CAPITAL CIR NE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4598
Practice Address - Country:US
Practice Address - Phone:850-216-2244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS478161835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy