Provider Demographics
NPI:1336445360
Name:MEDASSIST OF MECKLENBURG
Entity Type:Organization
Organization Name:MEDASSIST OF MECKLENBURG
Other - Org Name:NC MEDASSIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:GIANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-536-9766
Mailing Address - Street 1:601 E 5TH ST STE 350
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-3031
Mailing Address - Country:US
Mailing Address - Phone:704-536-1790
Mailing Address - Fax:704-536-9812
Practice Address - Street 1:601 E 5TH ST STE 350
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-3031
Practice Address - Country:US
Practice Address - Phone:704-536-1790
Practice Address - Fax:704-536-9812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7100333600000X, 3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy