Provider Demographics
NPI:1184915027
Name:CARR, THERESA L (RPH)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:L
Last Name:CARR
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 1:932 CROSS LANES DR
Mailing Address - Street 2:
Mailing Address - City:CROSS LANES
Mailing Address - State:WV
Mailing Address - Zip Code:25313-1315
Mailing Address - Country:US
Mailing Address - Phone:304-776-3276
Mailing Address - Fax:304-776-2108
Practice Address - Street 1:932 CROSS LANES DR
Practice Address - Street 2:
Practice Address - City:CROSS LANES
Practice Address - State:WV
Practice Address - Zip Code:25313-1315
Practice Address - Country:US
Practice Address - Phone:304-776-3276
Practice Address - Fax:304-776-2108
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP5163183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist