MEDICARE: KRISTINA RETCHO

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	23737	NC

General Provider Information

NPI Number	:	1881098390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA RETCHO

Provider Business Mailing Address
First Line	:	2913 WINDSOR AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-1325
Country	:	US
Telephone Number	:	561-371-4179
Fax Number	:

Provider Business Practice Location Address
First Line	:	9720 REA RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-6663
Country	:	US
Telephone Number	:	704-752-1164
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2014
Last Update Date	:	10/13/2014

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Directions to “ KRISTINA RETCHO ” Practice Location

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