Individual
MRS. JENNIFER D CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
149 POND FORT TRAIL, LAKE ST LOUIS, MO 63367-6890
(636) 621-1001
(636) 321-1005
Mailing address
149 POND FORT TRAIL, LAKE ST LOUIS, MO 63367-6890
(636) 621-1001
(636) 321-1005
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
2002027545
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2002027545
PHARMACIST LICENSE
MO
Enumeration date
10/04/2010
Last updated
11/04/2024
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