Provider Demographics
NPI:1639483720
Name:CARROLL, ERVIN MCKAY JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:ERVIN
Middle Name:MCKAY
Last Name:CARROLL
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:840 S BRIGHTLEAF BLVD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-4377
Mailing Address - Country:US
Mailing Address - Phone:919-934-7164
Mailing Address - Fax:919-934-0921
Practice Address - Street 1:840 S BRIGHTLEAF BLVD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4377
Practice Address - Country:US
Practice Address - Phone:919-934-7164
Practice Address - Fax:919-934-0921
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC06016183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist