Provider Demographics
NPI:1154439594
Name:CARLEN, JEFFREY D (RPH)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:D
Last Name:CARLEN
Suffix:
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 1:2600 STONYBROOK RD
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36804-7653
Mailing Address - Country:US
Mailing Address - Phone:334-705-2696
Mailing Address - Fax:334-280-7395
Practice Address - Street 1:2600 STONYBROOK RD
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36804-7653
Practice Address - Country:US
Practice Address - Phone:334-705-2696
Practice Address - Fax:334-280-7395
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS19073183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist