Healthcare Provider Details

I. General information

NPI: 1619163375
Provider Name (Legal Business Name): CHS PHARMACY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2007
Last Update Date: 03/07/2023
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 CAMERON VALLEY PKWY STE 1200
CHARLOTTE NC
28211-4371
US

IV. Provider business mailing address

PO BOX 603216
CHARLOTTE NC
28260-3216
US

V. Phone/Fax

Practice location:
  • Phone: 704-512-6040
  • Fax: 704-512-6041
Mailing address:
  • Phone: 704-512-7637
  • Fax: 704-512-7630

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 Number13265
License Number StateNC

VIII. Authorized Official

Name: NICHOLAS COLE WILSON
Title or Position: AVP PHARMACY SERVICES
Credential:
Phone: 704-512-7628