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General NPI Number Information
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NPI Number | 1316651482
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Entity Type | Organization
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Legal Business Name | PRIME SPECIALTY PHARMACY
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Dates
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Enumeration Date | 01/12/2023
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Last Update Date | 01/12/2023
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Provider Practice Location Address
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Address Line | 10215 MCINTYRE RIDGE RD SUITE 101
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City | PINEVILLE
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State | NC
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Zip | 28134
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Country | US
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Telephone | 301-204-3819
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Fax |
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Provider Business Mailing Address
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Address Line | 9622 PENSIVE LN
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City | WAXHAW
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State | NC
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Zip | 28173-3800
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | JIGNESH MANDAVIA
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Credential |
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Telephone | 301-204-3819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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