MEDICARE: PRECIOUS MICEALA PRINGLE PHARMD

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	14354	SC
2	183500000X	Pharmacist	25643	NC

General Provider Information

NPI Number	:	1902235161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRECIOUS MICEALA PRINGLE PHARMD

Provider Business Mailing Address
First Line	:	3400 WYLIE MEADOW LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-7714
Country	:	US
Telephone Number	:	803-983-2754
Fax Number	:

Provider Business Practice Location Address
First Line	:	3010 MONROE RD STE 101
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-7533
Country	:	US
Telephone Number	:	704-496-9182
Fax Number	:	704-496-9903

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

Provider Enumeration Date	:	11/07/2013
Last Update Date	:	02/05/2024

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