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Organization
PRUITTHEALTH PHARMACY SERVICES - CHARLOTTE HALL, INC
Active
Organization
PRUITTHEALTH PHARMACY SERVICES - CHARLOTTE HALL, INC
Active
Other names
Charlotte Hall Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LYNETHIA N HOLLEY (PROVIDER ENROLLMENT SPECIALIST)
(770) 506-6875
Entity
Organization
Contact information
Practice address
29449 CHARLOTTE HALL RD, CHARLOTTE HALL, MD 20622
(704) 548-7730
Mailing address
1626 JEURGENS CT, NORCROSS, GA 30093
(770) 279-6200
(833) 679-5232
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
269091800
—
MD
01
—
PW0548
STATE LICENSE
MD
Enumeration date
12/19/2014
Last updated
04/24/2024
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