Basic Information
| Provider Information | |||||||||
| NPI: | 1629520556 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARR | ||||||||
| FirstName: | DUSTIN | ||||||||
| MiddleName: | RYAN VERNON | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHARM.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4115 GLADSTONE ST | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152071423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2692148577 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | UNIVERSITY DRIVE A | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4128222222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2016 | ||||||||
| LastUpdateDate: | 10/26/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 5302039941 | MI | N | Pharmacy Service Providers | Pharmacist | 183500000X | 25376 | NC | N | Pharmacy Service Providers | Pharmacist | 183500000X | RP451080 | PA | N | Pharmacy Service Providers | Pharmacist | 1835P0018X | 3151003 | NC | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No ID Information.