Healthcare Provider Details

I. General information

NPI: 1568429785
Provider Name (Legal Business Name): JUAN D MOBLEY RPH, PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 MEDICAL PLAZA DR
CHARLOTTE NC
28262-8797
US

IV. Provider business mailing address

6400 FILLIAN LN
CHARLOTTE NC
28269-7165
US

V. Phone/Fax

Practice location:
  • Phone: 704-547-0020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number15115
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: