Healthcare Provider Details

I. General information

NPI: 1427467281
Provider Name (Legal Business Name): BENJAMIN GWATHMEY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5706 WYALONG DR
CHARLOTTE NC
28227-7843
US

IV. Provider business mailing address

5706 WYALONG DR
CHARLOTTE NC
28227-7843
US

V. Phone/Fax

Practice location:
  • Phone: 704-545-4106
  • Fax: 704-545-9526
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24152
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: