Provider Demographics
NPI:1134181050
Name:CARPENTER, JOHN W
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:CARPENTER
Suffix:
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:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:HAYNEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36040-0366
Mailing Address - Country:US
Mailing Address - Phone:334-548-2125
Mailing Address - Fax:
Practice Address - Street 1:12 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:HAYNEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36040
Practice Address - Country:US
Practice Address - Phone:334-548-2125
Practice Address - Fax:334-548-2126
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11181183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL11181OtherPHARMACIST