Provider Demographics
NPI:1588800478
Name:NALLE PHARMACY INC
Entity Type:Organization
Organization Name:NALLE PHARMACY INC
Other - Org Name:MINT HILL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAGENHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-342-8180
Mailing Address - Street 1:11304 HAWTHORNE DR
Mailing Address - Street 2:STE 120
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-9300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11304 HAWTHORNE DR
Practice Address - Street 2:STE 120
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-9300
Practice Address - Country:US
Practice Address - Phone:704-545-9687
Practice Address - Fax:704-545-1823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3412905OtherNCPDP PROVIDER IDENTIFICATION NUMBER