Healthcare Provider Details

I. General information

NPI: 1477330868
Provider Name (Legal Business Name): CAROL M ROBITAILLE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13845 CONLAN CIR
CHARLOTTE NC
28277-2705
US

IV. Provider business mailing address

1723 WALDEN POND LN
WAXHAW NC
28173-8366
US

V. Phone/Fax

Practice location:
  • Phone: 704-544-2092
  • Fax:
Mailing address:
  • Phone: 704-488-4484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14648
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: