Provider Demographics
NPI:1700304599
Name:CARTER, MARY LEE (RPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LEE
Last Name:CARTER
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 1:7135 STATE ROAD 52 STE 103
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-6748
Mailing Address - Country:US
Mailing Address - Phone:727-378-3594
Mailing Address - Fax:727-378-7264
Practice Address - Street 1:7135 STATE ROAD 52 STE 103
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-6748
Practice Address - Country:US
Practice Address - Phone:727-378-3594
Practice Address - Fax:727-378-7264
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS12988183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist