Provider Demographics
NPI:1700983673
Name:HEBERT, CARLA GROSE (RPH)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:GROSE
Last Name:HEBERT
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 1:3406 W 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-4431
Mailing Address - Country:US
Mailing Address - Phone:941-773-4320
Mailing Address - Fax:
Practice Address - Street 1:550 W 7TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3571
Practice Address - Country:US
Practice Address - Phone:907-622-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14460183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist