Healthcare Provider Details

I. General information

NPI: 1407982333
Provider Name (Legal Business Name): NAN TAUSCHER ENTERPRISES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2509 E OZARK AVE
GASTONIA NC
28054-1423
US

IV. Provider business mailing address

2509 E OZARK AVE
GASTONIA NC
28054-1423
US

V. Phone/Fax

Practice location:
  • Phone: 704-867-2728
  • Fax:
Mailing address:
  • Phone: 704-867-2728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number05629
License Number StateNC

VIII. Authorized Official

Name: NAN VIRGINIA TAUSCHER
Title or Position: OWNER
Credential: RPH
Phone: 704-867-2728