Provider Demographics
NPI:1548328677
Name:CARTERS AT STONE BRIDGE LLC
Entity type:Organization
Organization Name:CARTERS AT STONE BRIDGE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMRON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:931-433-1511
Mailing Address - Street 1:6 ELDAD RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-7005
Mailing Address - Country:US
Mailing Address - Phone:931-438-0760
Mailing Address - Fax:931-433-6854
Practice Address - Street 1:6 ELDAD RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-7005
Practice Address - Country:US
Practice Address - Phone:931-438-0760
Practice Address - Fax:931-433-6854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN43403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2095148OtherPK