MEDICARE: QUEEN CITY PHARMACY 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
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1801465539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUEEN CITY PHARMACY LLC

Provider Business Mailing Address
First Line	:	4123 ROSE LAKE DR STE E&F
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28217-2881
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4123 ROSE LAKE DR STE E&F
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28217-2881
Country	:	US
Telephone Number	:	650-353-5495
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	MOHAMMAD AFRIDI
Credential	:
Telephone Number	:	650-353-5495

Provider Enumeration Date	:	06/17/2021
Last Update Date	:	06/17/2021

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Directions to “QUEEN CITY PHARMACY LLC ” Practice Location

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