Provider Demographics
NPI:1609354737
Name:MCCORD, CARROL DUANE (RPH)
Entity Type:Individual
Prefix:
First Name:CARROL
Middle Name:DUANE
Last Name:MCCORD
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 1:17877 CHESTERFIELD AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-1211
Mailing Address - Country:US
Mailing Address - Phone:866-849-4481
Mailing Address - Fax:
Practice Address - Street 1:17877 CHESTERFIELD AIRPORT RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1211
Practice Address - Country:US
Practice Address - Phone:866-849-4481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042915183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist