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General NPI Number Information
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NPI Number | 1245759828
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Entity Type | Individual
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Provider Name | EDWARD PLUGOVOY
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Gender | Male
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Dates
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Enumeration Date | 09/14/2017
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Last Update Date | 09/14/2017
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Provider Practice Location Address
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Address Line | 2325 VILLAGE LAKE DR
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City | CHARLOTTE
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State | NC
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Zip | 28212-0081
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Country | US
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Telephone | 704-536-3663
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Fax |
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Provider Business Mailing Address
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Address Line | 10606 WILLIAMS RD
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City | MINT HILL
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State | NC
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Zip | 28227-9006
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Country | US
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Telephone | 704-756-1699
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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 | 27427
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License Number State | NC
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