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General NPI Number Information
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NPI Number | 1154741171
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Entity Type | Individual
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Provider Name | JONATHAN LOEFFLER
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Gender | Male
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Dates
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Enumeration Date | 04/17/2014
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Last Update Date | 06/08/2015
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Provider Practice Location Address
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Address Line | 9805 ROCKY RIVER RD
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City | CHARLOTTE
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State | NC
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Zip | 28215-8922
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Country | US
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Telephone | 704-494-3466
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Fax |
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Provider Business Mailing Address
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Address Line | 929 GARDEN DISTRICT DR
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City | CHARLOTTE
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State | NC
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Zip | 28202-2997
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Country | US
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Telephone | 412-477-7480
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | SC35420
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PHA.0020227
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 24808
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License Number State | NC
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