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NPI Code Detail

MEDICARE: LAX COTSWOLD LLC

MEDICARE: LAX COTSWOLD LLC
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
13336C0003XCommunity/Retail Pharmacy
23336C0004XCompounding Pharmacy
3333600000XPharmacy12986NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12159592OTHERPK

General Provider Information

NPI Number : 1396800710
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAX COTSWOLD LLC
Provider Business Mailing Address
First Line : 4390 COLWICK RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28211-2310
Country : US
Telephone Number : 704-364-3444
Fax Number : 704-364-1320
Provider Business Practice Location Address
First Line : 4390 COLWICK RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28211-2310
Country : US
Telephone Number : 704-364-3444
Fax Number : 704-364-1320
Authorized Official
Title or Position : OWNER
Name : VIPUL PATEL
Credential :
Telephone Number : 704-364-3444
Provider Enumeration Date : 12/26/2006
Last Update Date : 04/30/2019

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Directions to “LAX COTSWOLD LLC ” Practice Location

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