Provider Demographics
NPI:1629071147
Name:CARBAUGH, CHRIS RAY (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:RAY
Last Name:CARBAUGH
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 1:4953 ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:BLACKSHEAR
Mailing Address - State:GA
Mailing Address - Zip Code:31516-4576
Mailing Address - Country:US
Mailing Address - Phone:912-449-8527
Mailing Address - Fax:
Practice Address - Street 1:4953 ROBERTS RD
Practice Address - Street 2:
Practice Address - City:BLACKSHEAR
Practice Address - State:GA
Practice Address - Zip Code:31516-4576
Practice Address - Country:US
Practice Address - Phone:912-449-8527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-30
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA17933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist