Provider Demographics
NPI:1841889847
Name:ELSAMANI, LINA
Entity type:Individual
Prefix:
First Name:LINA
Middle Name:
Last Name:ELSAMANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 WILKINSON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-5634
Mailing Address - Country:US
Mailing Address - Phone:704-395-3670
Mailing Address - Fax:704-399-7605
Practice Address - Street 1:3440 WILKINSON BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-5634
Practice Address - Country:US
Practice Address - Phone:704-395-3670
Practice Address - Fax:704-399-7605
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25713183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist