Provider Demographics
NPI:1487924916
Name:CARSON, S. PHILLIP (PHARM D ; RPH)
Entity type:Individual
Prefix:DR
First Name:S.
Middle Name:PHILLIP
Last Name:CARSON
Suffix:
Gender:M
Credentials:PHARM D ; RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-3001
Mailing Address - Country:US
Mailing Address - Phone:662-840-6411
Mailing Address - Fax:662-840-4598
Practice Address - Street 1:2801 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-3001
Practice Address - Country:US
Practice Address - Phone:662-840-6411
Practice Address - Fax:662-840-4598
Is Sole Proprietor?:No
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-74501835N1003X
TN345411835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835N1003XPharmacy Service ProvidersPharmacistNutrition Support