Healthcare Provider Details

I. General information

NPI: 1972898849
Provider Name (Legal Business Name): MELISSA STONE CAGIDE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2011
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 GEORGE W LILES PKWY NW
CONCORD NC
28027-6532
US

IV. Provider business mailing address

361 GEORGE W LILES PKWY NW
CONCORD NC
28027-6532
US

V. Phone/Fax

Practice location:
  • Phone: 704-789-9681
  • Fax: 704-789-9687
Mailing address:
  • Phone: 704-789-9681
  • Fax: 704-789-9687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11455
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: