1407935984 NPI number — MR. JAMES FRED CARRICO RPH

Table of content: MR. JAMES FRED CARRICO RPH (NPI 1407935984)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407935984 NPI number — MR. JAMES FRED CARRICO RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARRICO
Provider First Name:
JAMES
Provider Middle Name:
FRED
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARRICO
Provider Other First Name:
JAMES
Provider Other Middle Name:
FRED
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPH
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1407935984
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2050 HIGHWAY 11 NORTH
Provider Second Line Business Mailing Address:
PO BOX 1108
Provider Business Mailing Address City Name:
BOONVEVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-593-0382
Provider Business Mailing Address Fax Number:
606-593-0384

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2050 HIGHWAY 11 NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOONVEVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-593-0382
Provider Business Practice Location Address Fax Number:
606-593-0384
Provider Enumeration Date:
11/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  007815 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)