Healthcare Provider Details

I. General information

NPI: 1861785479
Provider Name (Legal Business Name): JONATHAN ROBERT LANKFORD PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6133 THE PLZ
CHARLOTTE NC
28215-2401
US

IV. Provider business mailing address

200 E 2ND AVE
GASTONIA NC
28052-4358
US

V. Phone/Fax

Practice location:
  • Phone: 704-887-3840
  • Fax: 704-887-3844
Mailing address:
  • Phone: 704-874-1904
  • Fax: 704-864-7608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13186
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21041
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: