Healthcare Provider Details

I. General information

NPI: 1164143996
Provider Name (Legal Business Name): MECKLENBURG COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 05/04/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 STITT ROAD MECKLENBURG COUNTY PUBLIC HEALTH DEPARTMENT
CHARLOTTE NC
28213
US

IV. Provider business mailing address

249 BILLINGSLEY RD
CHARLOTTE NC
28211-1003
US

V. Phone/Fax

Practice location:
  • Phone: 704-336-6400
  • Fax: 704-432-0217
Mailing address:
  • Phone: 980-314-9126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. RAYNARD E WASHINGTON
Title or Position: HEALTH DIRECTOR
Credential:
Phone: 980-579-0671