Provider Demographics
NPI:1649541533
Name:QUEEN, CARLA KIRKLEY (PHARMACIST)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:KIRKLEY
Last Name:QUEEN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 CANTERBURY RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:SC
Mailing Address - Zip Code:29379-9687
Mailing Address - Country:US
Mailing Address - Phone:834-426-5806
Mailing Address - Fax:
Practice Address - Street 1:2195 SOUTHPORT RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-6257
Practice Address - Country:US
Practice Address - Phone:864-585-2576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6586183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist