Provider Demographics
NPI:1700175338
Name:CARR, LYNWOOD (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:LYNWOOD
Middle Name:
Last Name:CARR
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-3611
Mailing Address - Country:US
Mailing Address - Phone:601-684-2414
Mailing Address - Fax:601-684-1457
Practice Address - Street 1:1703 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-3611
Practice Address - Country:US
Practice Address - Phone:601-684-2414
Practice Address - Fax:601-684-1457
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-05117183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist