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Organization
TARGET
Active
Organization
TARGET
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SWATI PATHAK (PHARMACY MANAGER)
(704) 553-2903
Entity
Organization
Contact information
Practice address
9531 SOUTH BLVD, CHARLOTTE, NC 28273-6901
(704) 553-2903
Mailing address
9531 SOUTH BLVD, CHARLOTTE, NC 28273-6901
(704) 553-2903
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
22004
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0608059
—
NC
Enumeration date
12/01/2011
Last updated
12/01/2011
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