Provider Demographics
NPI:1639237761
Name:CARTERS INC
Entity Type:Organization
Organization Name:CARTERS INC
Other - Org Name:CARTERS DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PHARM
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMRON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:931-433-1511
Mailing Address - Street 1:106 ELK AVE S
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-3050
Mailing Address - Country:US
Mailing Address - Phone:931-433-1511
Mailing Address - Fax:931-433-6854
Practice Address - Street 1:106 ELK AVE S
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-3050
Practice Address - Country:US
Practice Address - Phone:931-433-1511
Practice Address - Fax:931-433-6854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
TN3673336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1452238Medicaid
2095469OtherPK
1167950001Medicare NSC
3910059Medicare PIN