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General NPI Number Information
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NPI Number | 1528386711
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Entity Type | Organization
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Legal Business Name | MEDASSIST OF MECKLENBURG
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Dates
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Enumeration Date | 05/12/2010
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Last Update Date | 05/12/2010
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Provider Practice Location Address
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Address Line | 5516 CENTRAL AVE
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City | CHARLOTTE
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State | NC
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Zip | 28212-2708
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Country | US
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Telephone | 704-536-1790
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Fax | 704-536-9865
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Provider Business Mailing Address
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Address Line | 5516 CENTRAL AVE
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City | CHARLOTTE
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State | NC
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Zip | 28212-2708
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Country | US
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Telephone | 704-536-1790
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Fax | 704-536-9865
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Authorized Official
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Title or Position | CEO/EXECUTIVE DIRECTOR
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Name | MRS. LORI GIANG
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Credential |
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Telephone | 704-536-1790
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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 | 07100
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License Number State | NC
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