NPIMap

Organization Active NPI

Nalle Pharmacy

  • Community/Retail Pharmacy
  • Charlotte, NC
National Provider Identifier
1639281900
Registry record updated Sep 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
7565 Issued in NC
Legal business name
NALLE PHARMACY
Practice address
1918 Randolph Rd
Ste 120
Charlotte, NC 28207-1100
Phone
(704) 342-8180
Fax
(704) 344-2243
NPI assigned
Aug 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2007

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

Authorized official

Name
Carl DagenhartNPI 1164735395
Title
Owner Pharmacy Manager
Phone
(704) 342-8180

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 7565 NC Primary
Compounding Pharmacy 3336C0004X
Specialty Pharmacy 3336S0011X

Addresses

Primary practice location

1918 Randolph Rd
Ste 120
Charlotte, NC 28207-1100

Mailing address

1918 Randolph Rd
Ste 120
Charlotte, NC 28207-1100

Other identifiers 2

IdentifierTypeStateIssuer
3421687OtherOTHER ID NUMBER
0609324MedicaidNC

Other names 1

  • NALLE PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210405000189 NC Part B Supplier - Mass Immunization (Roster Biller Only) 5698182988 Practice locations: Charlotte, NC

National Provider Directory

National Provider Directory
Tax ID family
Mint Hill Pharmacy3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

1918 Randolph Rd
Ste 120
Charlotte, NC 28207
Phone (704) 342-8180

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189641600000",
    "number": "1639281900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1918 RANDOLPH RD",
            "address_2": "STE 120",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282071100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1918 RANDOLPH RD",
            "address_2": "STE 120",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282071100",
            "telephone_number": "704-342-8180",
            "fax_number": "704-344-2243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NALLE PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-09-13",
        "status": "A",
        "authorized_official_last_name": "DAGENHART",
        "authorized_official_first_name": "CARL",
        "authorized_official_title_or_position": "OWNER PHARMACY MANAGER",
        "authorized_official_telephone_number": "704-342-8180"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NC",
            "license": "7565",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "3421687",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0609324",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NALLE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.