Provider Demographics
NPI:1902397813
Name:BOHANNON, CARRIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:
Last Name:BOHANNON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 BAYBERRY CIR UNIT 607
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5688
Mailing Address - Country:US
Mailing Address - Phone:770-548-4157
Mailing Address - Fax:
Practice Address - Street 1:1545 COUNTY ROAD 220
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-7922
Practice Address - Country:US
Practice Address - Phone:904-364-5766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH029323183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist