MEDICARE: PIKE'S PHARMACY, INC

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	333600000X	Pharmacy	04081	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	:	1811990146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIKE'S PHARMACY, INC

Provider Business Mailing Address
First Line	:	2133 SHAMROCK DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-2132
Country	:	US
Telephone Number	:	704-563-2286
Fax Number	:	704-563-8307

Provider Business Practice Location Address
First Line	:	2133 SHAMROCK DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-2132
Country	:	US
Telephone Number	:	704-563-2286
Fax Number	:	704-563-8307

Authorized Official
Title or Position	:	PHARMACIST OWNER
Name	:	JENNIFER LYNN KELLER
Credential	:
Telephone Number	:	704-563-2286

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	07/18/2025

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