Provider Demographics
NPI:1902974702
Name:CARTERS PHARMACY INC
Entity Type:Organization
Organization Name:CARTERS PHARMACY INC
Other - Org Name:CARTERS PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-748-1414
Mailing Address - Street 1:4704 AUGUSTA RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:GA
Mailing Address - Zip Code:31408-1758
Mailing Address - Country:US
Mailing Address - Phone:912-965-9911
Mailing Address - Fax:912-965-1732
Practice Address - Street 1:4704 AUGUSTA RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:GA
Practice Address - Zip Code:31408-1758
Practice Address - Country:US
Practice Address - Phone:912-965-9911
Practice Address - Fax:912-965-1732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GAPHRE0076803336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2018671OtherPK
GA000666003AMedicaid
0245270002Medicare NSC
GA1902974702OtherNPI
GA0245270002Medicare NSC