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Contact Information

PRUITTHEALTH PHARMACY SERVICES - CHARLOTTE HALL, INC
29449 CHARLOTTE HALL RD
CHARLOTTE HALL, MD20622
 Phone: 704-548-7730
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Long Term Care Pharmacy

3336L0003X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for PRUITTHEALTH PHARMACY SERVICES - CHARLOTTE HALL, INC

NPI # 1356749592
LBN Legal business name PRUITTHEALTH PHARMACY SERVICES - CHARLOTTE HALL, INC
Authorized official LYNETHIA HOLLEY - (PROVIDER ENROLLMENT SPECIALIST)
Entity Organization
Organization subpart 1 No
Enumeration date 12/19/2014
Last updated 04/24/2024 - About 2 years ago
Identifiers
MD Medicaid 269091800
MD Other PW0548 STATE LICENSE
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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