# PRUITTHEALTH PHARMACY SERVICES - CHARLOTTE HALL, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Charlotte Hall Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356749592
- **Authorized official:** MRS. LYNETHIA N HOLLEY (PROVIDER ENROLLMENT SPECIALIST)
- **Authorized official phone:** (770) 506-6875

## Contact information

- **Practice address:** 29449 CHARLOTTE HALL RD, CHARLOTTE HALL, MD 20622
- **Practice address phone:** (704) 548-7730
- **Mailing address:** 1626 JEURGENS CT, NORCROSS, GA 30093
- **Mailing address phone:** (770) 279-6200
- **Mailing address fax:** (833) 679-5232

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 12/19/2014
- **Last updated:** 04/24/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 269091800 | — | MD |
| 01 | — | PW0548 | STATE LICENSE | MD |