Provider Demographics
NPI:1275989287
Name:ANNOTATA, LLC
Entity Type:Organization
Organization Name:ANNOTATA, LLC
Other - Org Name:ANNOTATA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOETTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-351-9599
Mailing Address - Street 1:6300 E INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-6944
Mailing Address - Country:US
Mailing Address - Phone:980-430-1782
Mailing Address - Fax:980-498-0690
Practice Address - Street 1:6300 E INDEPENDENCE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-6944
Practice Address - Country:US
Practice Address - Phone:980-430-1782
Practice Address - Fax:980-498-0690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC129493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy