Provider Demographics
NPI:1841909728
Name:CARLSON, AUTUMN (PHARMD)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:CARLSON
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 1:899 STRAITS RD
Mailing Address - Street 2:
Mailing Address - City:NEW HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03256-4730
Mailing Address - Country:US
Mailing Address - Phone:603-937-0462
Mailing Address - Fax:
Practice Address - Street 1:899 STRAITS RD
Practice Address - Street 2:
Practice Address - City:NEW HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03256-4730
Practice Address - Country:US
Practice Address - Phone:603-937-0462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR71212183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist