Provider Demographics
NPI:1265582688
Name:CARROLL TOTAL CARE PHARMACY INC.
Entity type:Organization
Organization Name:CARROLL TOTAL CARE PHARMACY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:W
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:205-680-5557
Mailing Address - Street 1:6767 OLD SPRINGVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PINSON
Mailing Address - State:AL
Mailing Address - Zip Code:35126-3039
Mailing Address - Country:US
Mailing Address - Phone:205-680-5557
Mailing Address - Fax:205-680-5502
Practice Address - Street 1:6767 OLD SPRINGVILLE RD
Practice Address - Street 2:
Practice Address - City:PINSON
Practice Address - State:AL
Practice Address - Zip Code:35126-3039
Practice Address - Country:US
Practice Address - Phone:205-680-5557
Practice Address - Fax:205-680-5502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WD0400X, 261QM2500X, 3336C0004X
AL1105003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1000002717Medicaid