Provider Demographics
NPI:1740600535
Name:CARTER, FREDDIE (RPH)
Entity Type:Individual
Prefix:MR
First Name:FREDDIE
Middle Name:
Last Name:CARTER
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 1:2509 DECATUR STRATTON RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:MS
Mailing Address - Zip Code:39327-9458
Mailing Address - Country:US
Mailing Address - Phone:601-604-3815
Mailing Address - Fax:
Practice Address - Street 1:2509 DECATUR STRATTON RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:MS
Practice Address - Zip Code:39327-9458
Practice Address - Country:US
Practice Address - Phone:601-604-3815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE6219183500000X
TX28005183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist