Provider Demographics
NPI:1720662190
Name:CARTER, ALICE FAYE (CPHT)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:FAYE
Last Name:CARTER
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 OMACHE DR
Mailing Address - Street 2:
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-9672
Mailing Address - Country:US
Mailing Address - Phone:509-826-2806
Mailing Address - Fax:509-826-2808
Practice Address - Street 1:609 OMACHE DR
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841-9672
Practice Address - Country:US
Practice Address - Phone:509-826-2806
Practice Address - Fax:509-826-2808
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA60611831183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1143635OtherNABP
WAVA60611831OtherPHARMACY TECHNICIAN CERTIFCATION