Organization
NALLE PHARMACY
Active
Other names
NALLE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
CARL DAGENHART (OWNER PHARMACY MANAGER)
(704) 342-8180
Entity
Organization
Contact information
Practice address
1918 RANDOLPH RD, STE 120, CHARLOTTE, NC 28207-1100
(704) 342-8180
(704) 344-2243
Mailing address
1918 RANDOLPH RD, STE 120, CHARLOTTE, NC 28207-1100
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
7565
NC
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0609324
—
NC
01
—
3421687
OTHER ID NUMBER
—
Enumeration date
08/31/2006
Last updated
09/13/2007
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