Healthcare Provider Details

I. General information

NPI: 1568973253
Provider Name (Legal Business Name): JOLLY PATEL PHARMD, BCOP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10650 PARK RD STE 420
CHARLOTTE NC
28210-8539
US

IV. Provider business mailing address

9320 SCORPIO LN
MINT HILL NC
28227-3631
US

V. Phone/Fax

Practice location:
  • Phone: 980-442-9428
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number25473
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: