Healthcare Provider Details

I. General information

NPI: 1154626588
Provider Name (Legal Business Name): JONATHAN TOELLNER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2011
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1156 E CASWELL ST
WADESBORO NC
28170-2376
US

IV. Provider business mailing address

1156 E CASWELL ST
WADESBORO NC
28170-2376
US

V. Phone/Fax

Practice location:
  • Phone: 704-694-2153
  • Fax: 704-694-5126
Mailing address:
  • Phone: 704-694-2153
  • Fax: 704-694-5126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20562
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: