Provider Demographics
NPI:1912225764
Name:REVELL, CAROL (RPH)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:REVELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 WHITTINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4911
Mailing Address - Country:US
Mailing Address - Phone:502-327-8894
Mailing Address - Fax:502-425-3641
Practice Address - Street 1:315 WHITTINGTON PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4911
Practice Address - Country:US
Practice Address - Phone:502-327-8894
Practice Address - Fax:502-425-3641
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008213183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist