Provider Demographics
NPI:1265437776
Name:THROCKMORTON, CAROLL ANNE (RPH)
Entity type:Individual
Prefix:MRS
First Name:CAROLL
Middle Name:ANNE
Last Name:THROCKMORTON
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:P.O. BOX 1299
Mailing Address - Street 2:
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482
Mailing Address - Country:US
Mailing Address - Phone:804-435-8818
Mailing Address - Fax:804-435-8898
Practice Address - Street 1:308 N. MAIN STREET
Practice Address - Street 2:
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482
Practice Address - Country:US
Practice Address - Phone:804-435-8818
Practice Address - Fax:804-435-8898
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202010436183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist