Healthcare Provider Details

I. General information

NPI: 1811646672
Provider Name (Legal Business Name): MALLORY CARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 08/20/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 WEST BOULEVARD
CHARLOTTE NC
28208
US

IV. Provider business mailing address

2142 COMMONWEALTH AVE APT 222
CHARLOTTE NC
28205-5170
US

V. Phone/Fax

Practice location:
  • Phone: 980-402-1660
  • Fax: 980-402-1661
Mailing address:
  • Phone: 317-263-4906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number33426
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: