Provider Demographics
NPI:1700171766
Name:CHARLOTTE MECKLENBURG HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:CHARLOTTE MECKLENBURG HOSPITAL AUTHORITY
Other - Org Name:CMC RX MORROCROFT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, RETAIL PHARMACY
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:BROTHERTON
Authorized Official - Last Name:CHOINIERE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:704-512-7538
Mailing Address - Street 1:4525 CAMERON VALLEY PKWY
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-4369
Mailing Address - Country:US
Mailing Address - Phone:704-512-6040
Mailing Address - Fax:704-512-6041
Practice Address - Street 1:4525 CAMERON VALLEY PKWY
Practice Address - Street 2:SUITE 1200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-4369
Practice Address - Country:US
Practice Address - Phone:704-512-6040
Practice Address - Fax:704-512-6041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC98303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy