Provider Demographics
NPI:1174852776
Name:ROURK, JIM
Entity Type:Individual
Prefix:MR
First Name:JIM
Middle Name:
Last Name:ROURK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8601 UNIVERSITY EAST DR
Mailing Address - Street 2:PHARMACY
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-4353
Mailing Address - Country:US
Mailing Address - Phone:704-597-3500
Mailing Address - Fax:
Practice Address - Street 1:8601 UNIVERSITY EAST DR
Practice Address - Street 2:PHARMACY
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-4353
Practice Address - Country:US
Practice Address - Phone:704-597-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11439183500000X
KY013550183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist