Pruitthealth Pharmacy Services - Charlotte Hall, Inc

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

Legal business name

PRUITTHEALTH PHARMACY SERVICES - CHARLOTTE HALL, INC

Practice address

29449 Charlotte Hall Rd
Charlotte Hall, MD 20622

Phone

(704) 548-7730

NPI assigned

Dec 19, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Lynethia N Holley

Title

Provider Enrollment Specialist

Phone

(770) 506-6875

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Charlotte Hall Pharmacy Doing business as

Tax ID family

Charlotte Hall Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Pruitthealth Pharmacy Services - Charlotte Hall, Inc.

  • Pharmacy
  • Charlotte Hall, MD
  • NPI 1700662442
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1418947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713916800000",
    "number": "1356749592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1626 JEURGENS CT",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "30093",
            "telephone_number": "770-279-6200",
            "fax_number": "833-679-5232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29449 CHARLOTTE HALL RD",
            "city": "CHARLOTTE HALL",
            "state": "MD",
            "postal_code": "20622",
            "telephone_number": "704-548-7730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRUITTHEALTH PHARMACY SERVICES - CHARLOTTE HALL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-19",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-23",
        "status": "A",
        "authorized_official_last_name": "HOLLEY",
        "authorized_official_first_name": "LYNETHIA",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT SPECIALIST",
        "authorized_official_telephone_number": "770-506-6875",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "PW0548",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "269091800",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Charlotte Hall Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Charlotte Hall Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tara Ann Parsons, PT, DPT, PCS
• Pediatric Dentistry of Southern Maryland
• Breanne Elaine Peed, CRNP
• Maryrebecca Miller Pinckney, LCSW-C
• Patricia Plumer, CRNP
• Pruitthealth Pharmacy Services - Charlotte Hall, Inc.
• Pruitthealth Therapy Services, Inc.
• Pyramid Walden LLC
• Pyramid Walden LLC
• Pyramid Walden LLC

• Long Term Care Pharmacy in Charlotte Hall, MD
• Providers in Charlotte Hall, MD by specialty
• Long Term Care Pharmacy in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.