Provider Demographics
NPI:1659667749
Name:HUMPHRIES, CARRIE ALLISON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:ALLISON
Last Name:HUMPHRIES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9912 DUNBARTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BARNWELL
Mailing Address - State:SC
Mailing Address - Zip Code:29812-1442
Mailing Address - Country:US
Mailing Address - Phone:843-670-3419
Mailing Address - Fax:
Practice Address - Street 1:9912 DUNBARTON BLVD
Practice Address - Street 2:
Practice Address - City:BARNWELL
Practice Address - State:SC
Practice Address - Zip Code:29812-1442
Practice Address - Country:US
Practice Address - Phone:843-670-3419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13293183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist