Provider Demographics
NPI:1487003240
Name:CARSON, HERBERT (RPH, PHARMD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:
Last Name:CARSON
Suffix:
Gender:M
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 HOSPITAL DR
Mailing Address - Street 2:PHARMACY DEPT RM 3046
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2302
Mailing Address - Country:US
Mailing Address - Phone:740-592-9252
Mailing Address - Fax:740-592-9465
Practice Address - Street 1:55 HOSPITAL DR
Practice Address - Street 2:PHARMACY DEPT RM 3046
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2302
Practice Address - Country:US
Practice Address - Phone:740-592-9252
Practice Address - Fax:740-592-9465
Is Sole Proprietor?:No
Enumeration Date:2016-06-11
Last Update Date:2016-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03213740183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist