Provider Demographics
NPI:1235414939
Name:MCCULLOCH, CAROL JEAN (RPH)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:JEAN
Last Name:MCCULLOCH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:JEAN
Other - Last Name:GUIDINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 110
Mailing Address - Street 2:
Mailing Address - City:LITTLEROCK
Mailing Address - State:WA
Mailing Address - Zip Code:98556-0120
Mailing Address - Country:US
Mailing Address - Phone:360-456-2340
Mailing Address - Fax:
Practice Address - Street 1:1510 COOPER POINT RD SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5734
Practice Address - Country:US
Practice Address - Phone:360-570-8008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA11343183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist