Provider Demographics
NPI:1699373241
Name:CARTER, CARRIE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13820 RAVENSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-7104
Mailing Address - Country:US
Mailing Address - Phone:405-281-6363
Mailing Address - Fax:
Practice Address - Street 1:16925 NE 23RD ST STE 101
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-8410
Practice Address - Country:US
Practice Address - Phone:405-281-6363
Practice Address - Fax:405-281-1302
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14959183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist