Healthcare Provider Details

I. General information

NPI: 1982710554
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: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 HARDING PL STE 1400
CHARLOTTE NC
28204-2826
US

IV. Provider business mailing address

PO BOX 604357
CHARLOTTE NC
28260-4357
US

V. Phone/Fax

Practice location:
  • Phone: 704-468-3310
  • Fax: 704-468-3311
Mailing address:
  • Phone: 704-512-7637
  • Fax: 704-512-7630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRADLEY A CLARK
Title or Position: CFO
Credential:
Phone: 336-716-5099