Provider Demographics
NPI:1134411986
Name:CARROLL, BETHANY ANN (RPH)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:ANN
Last Name:CARROLL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02916-2117
Mailing Address - Country:US
Mailing Address - Phone:401-434-1333
Mailing Address - Fax:401-435-4569
Practice Address - Street 1:220 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:RI
Practice Address - Zip Code:02916-2117
Practice Address - Country:US
Practice Address - Phone:401-434-1333
Practice Address - Fax:401-435-4569
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH03963183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist