Healthcare Provider Details

I. General information

NPI: 1750652434
Provider Name (Legal Business Name): MRS. DARLENE LUELLA ZUEGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2012
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10012 WEISS WAY
WAXHAW NC
28173-0800
US

IV. Provider business mailing address

15823 SPARROWRIDGE CT
CHARLOTTE NC
28278-8844
US

V. Phone/Fax

Practice location:
  • Phone: 704-321-2694
  • Fax:
Mailing address:
  • Phone: 704-504-1376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16665
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16610
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051036400
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1247040
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: