Provider Demographics
NPI:1073293064
Name:POON, JEANNIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:
Last Name:POON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:980-302-7800
Mailing Address - Fax:980-302-7805
Practice Address - Street 1:134 MEDICAL PARK RD STE 200
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8527
Practice Address - Country:US
Practice Address - Phone:980-302-7800
Practice Address - Fax:980-302-7805
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC245751835C0206X
NC7004681835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835C0206XPharmacy Service ProvidersPharmacistCardiology