Provider Demographics
NPI:1144345752
Name:CARMON, MARK GERARD (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:GERARD
Last Name:CARMON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4735 CANDY CV
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-7719
Mailing Address - Country:US
Mailing Address - Phone:770-322-3811
Mailing Address - Fax:
Practice Address - Street 1:2383 LAKE HARBIN RD
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-1941
Practice Address - Country:US
Practice Address - Phone:770-961-5393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022217183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist