Provider Demographics
NPI:1255459400
Name:MCILWAIN, MICHAEL CECIL (RPH)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CECIL
Last Name:MCILWAIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5932 CARRIAGE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-3242
Mailing Address - Country:US
Mailing Address - Phone:704-598-6156
Mailing Address - Fax:704-599-2059
Practice Address - Street 1:8110 MALLARD CREEK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-2238
Practice Address - Country:US
Practice Address - Phone:704-509-2237
Practice Address - Fax:704-599-2059
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC082701835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy