Provider Demographics
NPI:1073893319
Name:MECKELNBURG COUNTY
Entity Type:Organization
Organization Name:MECKELNBURG COUNTY
Other - Org Name:MECKLENBURG COUNTY HEALTH DEPT - NORTHWEST CAMPUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAYNARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:980-579-0671
Mailing Address - Street 1:2845 BEATTIES FORD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-3711
Mailing Address - Country:US
Mailing Address - Phone:704-432-0343
Mailing Address - Fax:704-432-0347
Practice Address - Street 1:2845 BEATTIES FORD RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-3711
Practice Address - Country:US
Practice Address - Phone:704-432-0343
Practice Address - Fax:704-432-0347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-18
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC062413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1073893319Medicaid
3459179OtherNCPDP PROVIDER IDENTIFICATION NUMBER