Provider Demographics
NPI:1134100613
Name:CARROLL, JOHN B III (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:B
Last Name:CARROLL
Suffix:III
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 QUAIL TRL
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-9289
Mailing Address - Country:US
Mailing Address - Phone:229-924-9352
Mailing Address - Fax:229-931-5956
Practice Address - Street 1:181 QUAIL TRL
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-9289
Practice Address - Country:US
Practice Address - Phone:229-924-9352
Practice Address - Fax:229-931-5956
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA157011835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy