MEDICARE: ANSLEY GUIBAULT PHARMD

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	26524	NC

General Provider Information

NPI Number	:	1700328382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANSLEY GUIBAULT PHARMD

Provider Business Mailing Address
First Line	:	6010 E WT HARRIS BLVD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-4084
Country	:	US
Telephone Number	:	704-900-2832
Fax Number	:

Provider Business Practice Location Address
First Line	:	6010 E WT HARRIS BLVD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-4084
Country	:	US
Telephone Number	:	704-900-2832
Fax Number	:

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

Provider Enumeration Date	:	11/14/2016
Last Update Date	:	11/14/2016

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