=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841161411
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARITY AMENYA PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2025
-----------------------------------------------------
Last Update Date | 09/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 S MAIN ST
-----------------------------------------------------
City | GRAHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27253-3303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-229-9191
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4030 ST.CROIX LANE APT 204
-----------------------------------------------------
City | MEBANE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-210-0193
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 29928
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------