Provider Demographics
NPI:1275819989
Name:CARSON, FRANK JOSEPH
Entity Type:Individual
Prefix:MR
First Name:FRANK
Middle Name:JOSEPH
Last Name:CARSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-1509
Mailing Address - Country:US
Mailing Address - Phone:317-780-1990
Mailing Address - Fax:317-791-8433
Practice Address - Street 1:4001 MADISON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-1509
Practice Address - Country:US
Practice Address - Phone:317-780-1990
Practice Address - Fax:317-791-8433
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018563A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist