Provider Demographics
NPI:1811593445
Name:CARROLL, JEFFERY COLIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:COLIN
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 1:7401 I-30 FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402
Mailing Address - Country:US
Mailing Address - Phone:903-454-6646
Mailing Address - Fax:
Practice Address - Street 1:7401 I-30 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402
Practice Address - Country:US
Practice Address - Phone:903-454-6646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63597183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist