MEDICARE: JESSE MILLER PIKE JR. RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	05768	NC

General Provider Information

NPI Number	:	1386647626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSE MILLER PIKE JR. RPH

Provider Business Mailing Address
First Line	:	2133 SHAMROCK DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-2132
Country	:	US
Telephone Number	:	704-563-2286
Fax Number	:	704-563-8307

Provider Business Practice Location Address
First Line	:	2133 SHAMROCK DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-2132
Country	:	US
Telephone Number	:	704-563-2286
Fax Number	:	704-563-8307

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	07/08/2007

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