Carlton Wendell Durrence III, PHARMD
Individual provider Active NPI Pharmacist · Glennville, GA
NPI 1972097608 · NPPES record last updated Jun 16, 2018
Key facts
- NPI
- 1972097608
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- RPH013805 (GA)
- Practice address
- 15214 US Highway 301
Glennville, GA 30427 - Phone
- (912) 645-3224
- NPI assigned
- Jun 16, 2018
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH013805 | GA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH013805 | GA | Yes |
Addresses
Primary practice location
15214 US Highway 301
Glennville, GA 30427
Mailing address
15214 US Highway 301
Glennville, GA 30427-8308
Other providers in Glennville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 16, 2018. 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.