Provider Demographics
NPI:1265591150
Name:CARLSON, PAULA ANN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:ANN
Last Name:CARLSON
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 1:1208 W NISHNA RD
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:IA
Mailing Address - Zip Code:51601-2116
Mailing Address - Country:US
Mailing Address - Phone:712-246-3440
Mailing Address - Fax:
Practice Address - Street 1:1208 W NISHNA RD
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:IA
Practice Address - Zip Code:51601-2116
Practice Address - Country:US
Practice Address - Phone:712-246-3440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19976183500000X
NE12299183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0013862Medicaid