Provider Demographics
NPI:1518247303
Name:POWELL, CARL (PHARMD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:POWELL
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 1:1619 CALLE DEL RANCHERO NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-1112
Mailing Address - Country:US
Mailing Address - Phone:505-232-7878
Mailing Address - Fax:
Practice Address - Street 1:U.S. NAVAL HOSPITAL ROTA
Practice Address - Street 2:PSC 819 BOX 18
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09645-0018
Practice Address - Country:US
Practice Address - Phone:0113495-682-3305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007692183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist