Phillip Tyler Labauch, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

19024 Issued in NC

Practice address

1706 S Cannon Blvd
Kannapolis, NC 28083-6104

Phone

(704) 933-6337

Fax

(704) 933-6374

NPI assigned

Sep 13, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

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

{
    "created_epoch": "1347494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636502400000",
    "number": "1801146246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2413 GREENLAND AVE",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282085019",
            "telephone_number": "704-222-1424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1706 S CANNON BLVD",
            "city": "KANNAPOLIS",
            "state": "NC",
            "postal_code": "280836104",
            "telephone_number": "704-933-6337",
            "fax_number": "704-933-6374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LABAUCH",
        "first_name": "PHILLIP",
        "middle_name": "TYLER",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-09-13",
        "last_updated": "2021-11-10",
        "certification_date": "2021-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "SC",
            "license": "37545",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NC",
            "license": "19024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACIST LICENSE",
            "identifier": "19024",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACIST LICENSE",
            "identifier": "37545",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pharmacist in Kannapolis, NC
• Providers in Kannapolis, NC by specialty
• Pharmacist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2021; 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.