Provider Demographics
NPI:1295364537
Name:WRIGHT, CARL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13120 ROSSMOOR LN
Mailing Address - Street 2:
Mailing Address - City:ROCKTON
Mailing Address - State:IL
Mailing Address - Zip Code:61072-3264
Mailing Address - Country:US
Mailing Address - Phone:815-354-0200
Mailing Address - Fax:
Practice Address - Street 1:4843 BLUESTEM RD
Practice Address - Street 2:
Practice Address - City:ROSCOE
Practice Address - State:IL
Practice Address - Zip Code:61073-7794
Practice Address - Country:US
Practice Address - Phone:815-623-1696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.286054183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist