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PRUITTHEALTH PHARMACY SERVICES - CHARLOTTE HALL INC NPI 1356749592


NPI Information

NPI: 1356749592
Provider Name: PRUITTHEALTH PHARMACY SERVICES - CHARLOTTE HALL, INC

Doing Business As: CHARLOTTE HALL PHARMACY

Classification: Pharmacy - 3336L0003X
Entity Type: Organization

Specialization: Long Term Care Pharmacy

CLIA Number: 21D0987068

Address:
29449 CHARLOTTE HALL RD
CHARLOTTE HALL, MD
ZIP 20622
Phone: (704) 548-7730
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PRUITTHEALTH PHARMACY SERVICES - CHARLOTTE HALL, INC is a long term care pharmacy pharmacy in Charlotte Hall, MD. The provider is a pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. PRUITTHEALTH PHARMACY SERVICES - CHARLOTTE HALL, INC NPI is 1356749592. The provider is registered as an organization entity type.
The provider Is Doing Business As Charlotte Hall Pharmacy.

The provider's business location address is:

29449 CHARLOTTE HALL RD
CHARLOTTE HALL, MD
ZIP 20622
Phone: (704) 548-7730

The provider's authorized official is Lynethia N Holley .
The authorized official title is Provider Enrollment Specialist and has the following contact phone number (770) 506-6875.

The CLIA number assigned to this NPI record is 21D0987068 - community clinic with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 12/19/2014 and was last updated on 4/24/2024.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
13336L0003XPharmacyLong Term Care PharmacyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1PW0548OTHERMARYLANDSTATE LICENSE
2269091800MEDICAIDMARYLAND

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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