Provider Demographics
NPI:1477330868
Name:ROBITAILLE, CAROL M (PHARMD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:M
Last Name:ROBITAILLE
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 1:1723 WALDEN POND LN
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-8366
Mailing Address - Country:US
Mailing Address - Phone:704-488-4484
Mailing Address - Fax:
Practice Address - Street 1:13845 CONLAN CIR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2705
Practice Address - Country:US
Practice Address - Phone:704-544-2092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14648183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist