Active NPI
Mary Puckett Carroll, RPH
- Pharmacist
- Crystal River, FL
National Provider Identifier
1043736465
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS53020
- Practice address
- 6201 N Suncoast Blvd
Crystal River, FL 34428-6712 - Phone
- (352) 795-8460
- NPI assigned
- Aug 17, 2017
- Last updated
- Jul 21, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 8070 | NC | |
| Pharmacist | 183500000X | PS53020 | FL | Primary |
Addresses
Primary practice location
6201 N Suncoast Blvd
Crystal River, FL 34428-6712
Mailing address
6201 N Suncoast Blvd
Crystal River, FL 34428-6712
Phone (352) 795-8460
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8070 | NC | MD | Orthodontics and Dentofacial Orthopedic Dentist |
| PS53020 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1502928000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1043736465",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6201 N SUNCOAST BLVD",
"city": "CRYSTAL RIVER",
"state": "FL",
"postal_code": "344286712",
"telephone_number": "352-795-8460"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6201 N SUNCOAST BLVD",
"city": "CRYSTAL RIVER",
"state": "FL",
"postal_code": "344286712",
"telephone_number": "352-795-8460"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARROLL",
"first_name": "MARY",
"middle_name": "PUCKETT",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-08-17",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NC",
"license": "8070",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS53020",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crystal River, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.