Provider Demographics
NPI:1649562851
Name:GARRETT, JOHN E (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:GARRETT
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 1:5810 PROSPERITY CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-1138
Mailing Address - Country:US
Mailing Address - Phone:704-875-7128
Mailing Address - Fax:704-875-7378
Practice Address - Street 1:5810 PROSPERITY CHURCH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-1138
Practice Address - Country:US
Practice Address - Phone:704-875-7128
Practice Address - Fax:704-875-7378
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC007185183500000X
VA0202005096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist