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General NPI Number Information
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NPI Number | 1467744961
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Entity Type | Organization
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Legal Business Name | TAH FAMILY CORP
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Dates
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Enumeration Date | 05/03/2011
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Last Update Date | 08/15/2012
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Provider Practice Location Address
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Address Line | 10707 PARK RD STE B
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City | CHARLOTTE
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State | NC
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Zip | 28210-0107
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Country | US
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Telephone | 704-817-8080
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Fax | 704-817-7661
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Provider Business Mailing Address
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Address Line | 10707 PARK RD STE B
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City | CHARLOTTE
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State | NC
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Zip | 28210-0107
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Country | US
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Telephone | 704-817-8080
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Fax | 704-817-7661
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Authorized Official
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Title or Position | PHARMACIST
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Name | DR. KELA DELPHINE NJIKE TAH
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Credential | PHARM D
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Telephone | 704-817-8080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 11021
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License Number State | NC
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