Provider Demographics
NPI:1750827283
Name:CARLSON, JAMES (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:CARLSON
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18468 DALY CT
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:CA
Mailing Address - Zip Code:95327-9644
Mailing Address - Country:US
Mailing Address - Phone:209-984-3746
Mailing Address - Fax:
Practice Address - Street 1:2182 HIGHWAY 4
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:CA
Practice Address - Zip Code:95223-9908
Practice Address - Country:US
Practice Address - Phone:209-795-1155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-08
Last Update Date:2017-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32281183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist