Provider Demographics
NPI:1700989324
Name:CARROLL PHARMACY INC
Entity Type:Organization
Organization Name:CARROLL PHARMACY INC
Other - Org Name:CARROLL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:ERVIN
Authorized Official - Middle Name:MCKAY
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:JR
Authorized Official - Credentials:REG PHARMACIST RPH
Authorized Official - Phone:919-934-7164
Mailing Address - Street 1:840 S BRIGHTLEAF BLVD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-4377
Mailing Address - Country:US
Mailing Address - Phone:919-934-7164
Mailing Address - Fax:919-934-0921
Practice Address - Street 1:840 S BRIGHTLEAF BLVD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4377
Practice Address - Country:US
Practice Address - Phone:919-934-7164
Practice Address - Fax:919-934-0921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3326333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7700865OtherMEDICAID DME
NC0515296Medicaid
NC0515296Medicaid