Provider Demographics
NPI:1023321957
Name:CARBONE, MICHAEL A (RPH)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:CARBONE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18560 HARBOR LIGHT WAY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-4928
Mailing Address - Country:US
Mailing Address - Phone:561-789-3935
Mailing Address - Fax:561-488-6333
Practice Address - Street 1:9101 LAKERIDGE BLVD
Practice Address - Street 2:SUITE #10
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-2181
Practice Address - Country:US
Practice Address - Phone:561-487-9260
Practice Address - Fax:561-488-6333
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS23397183500000X
NC20925183500000X
NJ28RI01961800183500000X
MAPH21871183500000X
MD17399183500000X
NY036695-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist