Provider Demographics
NPI:1689098741
Name:CARROLL, RICHARD GERARD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GERARD
Last Name:CARROLL
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 1:6609 HAGEN BLVD
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-1716
Mailing Address - Country:US
Mailing Address - Phone:510-233-7270
Mailing Address - Fax:
Practice Address - Street 1:6609 HAGEN BLVD
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-1716
Practice Address - Country:US
Practice Address - Phone:510-233-7270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH55475183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist