=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093606204
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AVEEDA THAVICHITH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2025
-----------------------------------------------------
Last Update Date | 07/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6802 W WILKINSON BLVD
-----------------------------------------------------
City | BELMONT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28012-6204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-829-5681
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3602 SUMMEROW RD
-----------------------------------------------------
City | LINCOLNTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28092-7103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-956-7625
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 33973
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------