1427770452 NPI number — RICHARD PAGE CARTER IV PHARM D

Table of content: RICHARD PAGE CARTER IV PHARM D (NPI 1427770452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427770452 NPI number — RICHARD PAGE CARTER IV PHARM D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARTER
Provider First Name:
RICHARD
Provider Middle Name:
PAGE
Provider Name Prefix Text:
Provider Name Suffix Text:
IV
Provider Credential Text:
PHARM D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427770452
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 MEADOWVALE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATSONTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17777-9526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-490-2697
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1849 LYCOMING CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSPORT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17701-1523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-323-1338
Provider Business Practice Location Address Fax Number:
570-323-8476
Provider Enumeration Date:
09/15/2022

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:  RP456256 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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