=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396982773
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCJT PHARMACEUTICAL CARE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2009
-----------------------------------------------------
Last Update Date | 12/27/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 161 HICKMAN AVE
-----------------------------------------------------
City | HUDSON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28638-2449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-572-2655
-----------------------------------------------------
Fax | 828-572-2658
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 161 HICKMAN AVE
-----------------------------------------------------
City | HUDSON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28638-2449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-572-2655
-----------------------------------------------------
Fax | 828-572-2658
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/OWNER
-----------------------------------------------------
Name | DR. MELANIE C CLINE
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 828-572-2655
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P0018X
-----------------------------------------------------
Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
-----------------------------------------------------
License Number | 16803
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------