Provider Demographics
NPI:1740490572
Name:CARR, JODIE REAVES (PHARMD)
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:REAVES
Last Name:CARR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 BROOKLINE RD
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-4693
Mailing Address - Country:US
Mailing Address - Phone:205-631-8361
Mailing Address - Fax:
Practice Address - Street 1:7895 HIGHWAY 119 STE 6
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-7554
Practice Address - Country:US
Practice Address - Phone:205-621-8407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14791183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist