Provider Demographics
NPI:1578152013
Name:CARNES, CHRISTIAN WAITE (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:WAITE
Last Name:CARNES
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 1:408 E FRENCHMANS BEND RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-8852
Mailing Address - Country:US
Mailing Address - Phone:318-450-9383
Mailing Address - Fax:
Practice Address - Street 1:2801 LOUISVILLE AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6655
Practice Address - Country:US
Practice Address - Phone:318-387-6023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023540183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist