Healthcare Provider Details

I. General information

NPI: 1427164052
Provider Name (Legal Business Name): CAROLINAS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 EASTWAY DR
CHARLOTTE NC
28213-7103
US

IV. Provider business mailing address

PO BOX 602452
CHARLOTTE NC
28260-2452
US

V. Phone/Fax

Practice location:
  • Phone: 704-446-0902
  • Fax: 704-446-0968
Mailing address:
  • Phone: 704-446-0902
  • Fax: 704-446-0968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. DON MABE
Title or Position: CHIEF PHARMACY OFFICER
Credential: RPH, MBA, MHA
Phone: 704-512-6967