Provider Demographics
NPI:1396729877
Name:CARROLL, ELIZABETH M (RPH)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:M
Last Name:CARROLL
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 1:181 QUAIL TRL
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-9289
Mailing Address - Country:US
Mailing Address - Phone:229-924-8751
Mailing Address - Fax:229-931-5956
Practice Address - Street 1:181 QUAIL TRL
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-9289
Practice Address - Country:US
Practice Address - Phone:229-924-8751
Practice Address - Fax:229-931-5956
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA146481835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA14648OtherPHARMACIST LICENSE