Provider Demographics
NPI:1760498273
Name:GAYNOR, CAREY WOOTEN JR (RPH)
Entity type:Individual
Prefix:MR
First Name:CAREY
Middle Name:WOOTEN
Last Name:GAYNOR
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5109 NC 222
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:27829
Mailing Address - Country:US
Mailing Address - Phone:252-749-5561
Mailing Address - Fax:252-749-5561
Practice Address - Street 1:329 N FAIRVIEW ROAD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27801
Practice Address - Country:US
Practice Address - Phone:252-442-8159
Practice Address - Fax:252-442-0332
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5927183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3401964OtherNABP