Healthcare Provider Details

I. General information

NPI: 1639921026
Provider Name (Legal Business Name): JENNIFER LIRIANO SUAREZ PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWTHORNE LN
CHARLOTTE NC
28204-2515
US

IV. Provider business mailing address

3333 SILAS CREEK PKWY
WINSTON SALEM NC
27103-3013
US

V. Phone/Fax

Practice location:
  • Phone: 704-316-4610
  • Fax:
Mailing address:
  • Phone: 929-324-6095
  • Fax: 859-323-0069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number700619
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number33975
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: