Individual
JIM COATES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
500 TYVOLA RD, CHARLOTTE, NC 28217-3504
(704) 501-2402
Mailing address
500 TYVOLA RD, CHARLOTTE, NC 28217-3504
Taxonomy
Speciality
Code
Description
License number
State
1835G0303X
Geriatric Pharmacist
Primary
14077
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26031229
DRIVERS LICENSE
NC
Enumeration date
09/20/2014
Last updated
09/20/2014
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