Provider Demographics
NPI:1811273022
Name:CARLTON, GREGG A (PHARM D)
Entity type:Individual
Prefix:
First Name:GREGG
Middle Name:A
Last Name:CARLTON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 LOCHAVEN ALCOVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-8865
Mailing Address - Country:US
Mailing Address - Phone:651-739-8286
Mailing Address - Fax:
Practice Address - Street 1:6061 OSGOOD AVE N
Practice Address - Street 2:
Practice Address - City:OAK PARK HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55082-6133
Practice Address - Country:US
Practice Address - Phone:651-689-0046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116802183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist