Provider Demographics
NPI:1922601236
Name:CARPENTER, RONDA LYNN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RONDA
Middle Name:LYNN
Last Name:CARPENTER
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 1:1100 W ELK AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-2951
Mailing Address - Country:US
Mailing Address - Phone:423-543-7501
Mailing Address - Fax:
Practice Address - Street 1:1100 W ELK AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2951
Practice Address - Country:US
Practice Address - Phone:423-543-7501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN034315183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist