Provider Demographics
NPI:1922613413
Name:CARROLL, IESHA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:IESHA
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:IESHA
Other - Middle Name:
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:12007 LAMEY BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DIBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540-8907
Mailing Address - Country:US
Mailing Address - Phone:228-392-2388
Mailing Address - Fax:
Practice Address - Street 1:12007 LAMEY BRIDGE RD
Practice Address - Street 2:
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-8907
Practice Address - Country:US
Practice Address - Phone:228-392-2388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-15121183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist