Provider Demographics
NPI:1083999122
Name:CARTERS PHARMACY RX LLC
Entity Type:Organization
Organization Name:CARTERS PHARMACY RX LLC
Other - Org Name:CARTER'S PHARMACY RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-239-7519
Mailing Address - Street 1:14019 SOUTHWEST FWY STE 301-241
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3563
Mailing Address - Country:US
Mailing Address - Phone:281-239-7519
Mailing Address - Fax:281-966-1845
Practice Address - Street 1:1202 LARK LN STE 3
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-7433
Practice Address - Country:US
Practice Address - Phone:281-239-7519
Practice Address - Fax:281-966-1845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-20
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX276473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX350237Medicaid
2132328OtherPK