Healthcare Provider Details

I. General information

NPI: 1770007478
Provider Name (Legal Business Name): CHANTELLE HOILETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 08/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 W WILLIAMS ST
APEX NC
27502-1881
US

IV. Provider business mailing address

434 ANNA ST
LILLINGTON NC
27546-5124
US

V. Phone/Fax

Practice location:
  • Phone: 919-363-1471
  • Fax:
Mailing address:
  • Phone: 954-873-6455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number27279
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier27279
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerNORTH CAROLINA BOARD OF PHARMACY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: