Provider Demographics
NPI:1558391995
Name:CARPENTER, MICHAEL E (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11400 158TH RD
Mailing Address - Street 2:PO BOX 249
Mailing Address - City:MAYETTA
Mailing Address - State:KS
Mailing Address - Zip Code:66509
Mailing Address - Country:US
Mailing Address - Phone:785-966-8266
Mailing Address - Fax:785-966-8396
Practice Address - Street 1:11400 158TH RD
Practice Address - Street 2:
Practice Address - City:MAYETTA
Practice Address - State:KS
Practice Address - Zip Code:66509
Practice Address - Country:US
Practice Address - Phone:785-966-8266
Practice Address - Fax:785-966-8396
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-10852183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSBP8683941OtherDEA