Provider Demographics
NPI:1316218050
Name:PELLEGRINI, MARK (PHARMD, DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:PELLEGRINI
Suffix:
Gender:M
Credentials:PHARMD, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8417 BRISTOL FORD PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-9398
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8417 BRISTOL FORD PL
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-9398
Practice Address - Country:US
Practice Address - Phone:972-989-9988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21788183500000X
NC3771111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No183500000XPharmacy Service ProvidersPharmacist