Provider Demographics
NPI:1255593679
Name:MCGUIRE, CARLA (PHARMD)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:MCGUIRE
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 1:111 LONE WOLF DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-7029
Mailing Address - Country:US
Mailing Address - Phone:601-859-5415
Mailing Address - Fax:601-859-5434
Practice Address - Street 1:111 LONE WOLF DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-7029
Practice Address - Country:US
Practice Address - Phone:601-859-5415
Practice Address - Fax:601-859-5434
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE9195183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist