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General NPI Number Information
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NPI Number | 1902251978
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Entity Type | Organization
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Legal Business Name | CAROLINA FAMILY HEALTHCARE, PA
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Dates
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Enumeration Date | 04/27/2016
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Last Update Date | 04/27/2016
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Provider Practice Location Address
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Address Line | 11220 ELM LN SUITE 102
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City | CHARLOTTE
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State | NC
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Zip | 28277-0715
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Country | US
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Telephone | 704-847-4000
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Fax | 704-847-4001
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Provider Business Mailing Address
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Address Line | 11220 ELM LN SUITE 102
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City | CHARLOTTE
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State | NC
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Zip | 28277-0715
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Country | US
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Telephone | 704-847-4000
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Fax | 704-847-4001
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DINO KANELOS
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Credential | MD
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Telephone | 704-847-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 03735
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License Number State | NC
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