Healthcare Provider Details

I. General information

NPI: 1487047874
Provider Name (Legal Business Name): LAX GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2015
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8035 PROVIDENCE RD STE 300
CHARLOTTE NC
28277-8907
US

IV. Provider business mailing address

8035 PROVIDENCE RD STE 100
CHARLOTTE NC
28277-9716
US

V. Phone/Fax

Practice location:
  • Phone: 704-909-4700
  • Fax: 704-752-4197
Mailing address:
  • Phone: 704-909-4700
  • Fax: 704-752-4197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number12639
License Number StateNC

VIII. Authorized Official

Name: DR. VIPUL PATEL
Title or Position: OWNER
Credential: PHARMD
Phone: 704-909-4700