Macon Devaughn Carroll, PHARM.D.

Primary specialty

PharmacistTaxonomy code 183500000X

License

0000036920 Issued in TN

Practice address

107 JV Mangubat Dr
Waynesboro, TN 38485-2440

Phone

(931) 722-2296

Fax

(931) 722-3464

NPI assigned

Aug 2, 2012

Last updated

Dec 6, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Duren Clinical Services

  dba Durens Clinic Pharmacy

  • Community/Retail Pharmacy
  • Waynesboro, TN
  • NPI 1285067280
  NPD
• Duren Clinical Services, LLC

  dba Duren Pharmacy

  • Community/Retail Pharmacy
  • Waynesboro, TN
  • NPI 1821054289
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1343865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670284800000",
    "number": "1083960504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 DEXTER L WOODS MEMORIAL BLVD",
            "city": "WAYNESBORO",
            "state": "TN",
            "postal_code": "384852416",
            "telephone_number": "931-722-5466",
            "fax_number": "931-722-9495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 JV MANGUBAT DR",
            "city": "WAYNESBORO",
            "state": "TN",
            "postal_code": "384852440",
            "telephone_number": "931-722-2296",
            "fax_number": "931-722-3464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "MACON",
        "middle_name": "DEVAUGHN",
        "name_prefix": "Dr.",
        "credential": "PHARM.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-08-02",
        "last_updated": "2022-12-06",
        "certification_date": "2022-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TN",
            "license": "0000036920",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF PHARMACY LICENSE",
            "identifier": "36920",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "macon.carroll@durendrugs.com",
            "affiliation": "N",
            "address_1": "107 Jv Mangubat Dr",
            "city": "Waynesboro",
            "state": "TN",
            "country_code": "US",
            "postal_code": "384852440",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jacoby Brewer, PT, DPT
• Brian David Brison, PTA
• Buffalo River Services, Inc.
• Ryan Owen Bundren, LADAC II
• Chelsea Leigh Butcher
• Shelia Gaye Carroll, COTA/L
• Angeline Agnes Casteel, C.PH.T
• Patricia D Castleman, FNP-C
• Centerstone
• Robert Coble, MD

• Pharmacist in Waynesboro, TN
• Providers in Waynesboro, TN by specialty
• Pharmacist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 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.

Verify at the official NPI Registry.