Provider Demographics
NPI:1780460709
Name:CARTER, JOHN KENNETH SR
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:KENNETH
Last Name:CARTER
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2089 RED BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:LORIS
Mailing Address - State:SC
Mailing Address - Zip Code:29569-6043
Mailing Address - Country:US
Mailing Address - Phone:843-421-8211
Mailing Address - Fax:
Practice Address - Street 1:236 W MCINTYRE ST
Practice Address - Street 2:
Practice Address - City:MULLINS
Practice Address - State:SC
Practice Address - Zip Code:29574-3524
Practice Address - Country:US
Practice Address - Phone:843-464-0372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2023-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5883183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist