Provider Demographics
NPI:1922009364
Name:CARPENTER, NEIL WAYNE (DPH)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:WAYNE
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 SOUTH MAIN STREET
Mailing Address - Street 2:P O BOX 127
Mailing Address - City:EAGLEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37060
Mailing Address - Country:US
Mailing Address - Phone:615-274-6868
Mailing Address - Fax:615-274-2324
Practice Address - Street 1:1005 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:EAGLEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37060
Practice Address - Country:US
Practice Address - Phone:615-274-6868
Practice Address - Fax:615-274-2324
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC5037183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist