Provider Demographics
NPI:1629520556
Name:CARR, DUSTIN RYAN VERNON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:RYAN VERNON
Last Name:CARR
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 1:4115 GLADSTONE ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15207-1423
Mailing Address - Country:US
Mailing Address - Phone:269-214-8577
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY DRIVE A
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15240
Practice Address - Country:US
Practice Address - Phone:412-822-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302039941183500000X
NC25376183500000X
PARP451080183500000X
NC31510031835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist