MEDICARE: TARGET

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	22004	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760750061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TARGET

Provider Business Mailing Address
First Line	:	9531 SOUTH BLVD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28273-6901
Country	:	US
Telephone Number	:	704-553-2903
Fax Number	:

Provider Business Practice Location Address
First Line	:	9531 SOUTH BLVD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28273-6901
Country	:	US
Telephone Number	:	704-553-2903
Fax Number	:

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	SWATI PATHAK
Credential	:
Telephone Number	:	704-553-2903

Provider Enumeration Date	:	12/01/2011
Last Update Date	:	12/01/2011

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Directions to “TARGET ” Practice Location

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