Provider Demographics
NPI:1548459654
Name:CARROLL, REBECCA LOUISE (RPH)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LOUISE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 S 2ND ST
Mailing Address - Street 2:P.O. BOX 1076
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-1947
Mailing Address - Country:US
Mailing Address - Phone:740-295-7010
Mailing Address - Fax:
Practice Address - Street 1:720 S 2ND ST
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-1947
Practice Address - Country:US
Practice Address - Phone:740-295-7010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-23170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist