Carroll Bruister III
Individual provider Active NPI Pharmacist · Ackerman, MS
NPI 1982122289 · NPPES record last updated Sep 7, 2017
Key facts
- NPI
- 1982122289
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- E6788 (MS)
- Practice address
- 222 Mabus
Ackerman, MS 39735 - Phone
- (662) 285-6039
- NPI assigned
- Sep 7, 2017
- 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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E6788 | MS | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | E6788 | MS | Yes |
Addresses
Primary practice location
222 Mabus
Ackerman, MS 39735
Mailing address
11850 Ms Hwy 15
Ackerman, MS 39735
Other providers in Ackerman, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 7, 2017. 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.