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General NPI Number Information
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NPI Number | 1750269080
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Entity Type | Individual
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Provider Name | LILLIE MATTOX PHARMD
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Gender | Female
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Dates
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Enumeration Date | 08/25/2025
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 1900 SCOTT AVE STE 200B
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City | CHARLOTTE
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State | NC
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Zip | 28203-6046
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Country | US
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Telephone | 704-381-0260
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Fax | 704-381-0261
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Provider Business Mailing Address
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Address Line | 4525 CAMERON VALLEY PKWY STE 3100
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City | CHARLOTTE
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State | NC
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Zip | 28211-4377
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Country | US
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Telephone | 704-534-6862
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Fax | 704-355-5168
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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 | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | 24742
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License Number State | NC
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