Mary Puckett Carroll, RPH
Individual provider Active NPI Pharmacist · Crystal River, FL
NPI 1043736465 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1043736465
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PS53020 (FL)
- Practice address
- 6201 N Suncoast Blvd
Crystal River, FL 34428-6712 - Phone
- (352) 795-8460
- NPI assigned
- Aug 17, 2017
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS53020 | FL | MD | Pharmacist |
| 8070 | NC | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 8070 | NC | |
| Pharmacist | 183500000X | PS53020 | FL | Yes |
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
Other providers in Crystal River, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.