Provider Demographics
NPI:1578608907
Name:CARR, ROBERT H (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:H
Last Name:CARR
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:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:BASSFIELD
Mailing Address - State:MS
Mailing Address - Zip Code:39421-0547
Mailing Address - Country:US
Mailing Address - Phone:601-943-6913
Mailing Address - Fax:601-943-6327
Practice Address - Street 1:345 GEN ROBERT E BLOUNT DR
Practice Address - Street 2:
Practice Address - City:BASSFIELD
Practice Address - State:MS
Practice Address - Zip Code:39421
Practice Address - Country:US
Practice Address - Phone:601-943-6913
Practice Address - Fax:601-943-6327
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-7892183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2585959OtherNCPDP #
MS00030433Medicaid