MEDICARE: CHARLOTTE LIGHTELL 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	06898	NC

General Provider Information

NPI Number	:	1750877817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLOTTE LIGHTELL RPH

Provider Business Mailing Address
First Line	:	683 S HUGHES BLVD
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-4530
Country	:	US
Telephone Number	:	252-331-1306
Fax Number	:

Provider Business Practice Location Address
First Line	:	683 S HUGHES BLVD
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-4530
Country	:	US
Telephone Number	:	252-331-1306
Fax Number	:

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

Provider Enumeration Date	:	07/02/2018
Last Update Date	:	07/02/2018

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Directions to “ CHARLOTTE LIGHTELL RPH” Practice Location

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