=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811646672
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MALLORY CARTER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2022
-----------------------------------------------------
Last Update Date | 08/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1940 WEST BOULEVARD
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 980-402-1660
-----------------------------------------------------
Fax | 980-402-1661
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2142 COMMONWEALTH AVE APT 222
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28205-5170
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-263-4906
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P2201X
-----------------------------------------------------
Taxonomy Name | Ambulatory Care Pharmacist
-----------------------------------------------------
License Number | 33426
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------