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General NPI Number Information
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NPI Number | 1790842193
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Entity Type | Organization
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Legal Business Name | ID CONSULTANTS PA
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 4539 HEDGEMORE DR STE 110
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City | CHARLOTTE
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State | NC
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Zip | 28209-3276
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Country | US
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Telephone | 704-523-6049
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Fax | 704-523-6059
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Provider Business Mailing Address
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Address Line | 4539 HEDGEMORE DR STE 110
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City | CHARLOTTE
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State | NC
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Zip | 28209-3276
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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 | PHCY DIR
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Name | MR. BILL LAMB
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Credential | RPH MBA
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Telephone | 704-523-6049
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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 | 07526
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License Number State | NC
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