Organization Active NPI

Medi-Service of Charlotte Inc

  • Community/Retail Pharmacy
  • Monroe, NC
National Provider Identifier
1821195751
Registry record updated Oct 24, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
11378 Issued in NC
Legal business name
MEDI-SERVICE OF CHARLOTTE INC
Practice address
610 E Franklin St
Monroe, NC 28112-5702
Phone
(704) 289-1523
Fax
(855) 841-5354
NPI assigned
Sep 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2017

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

Authorized official

Name
Robin Fleischman
Title
Owner
Phone
(704) 516-2121

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 11378 NC Primary

Addresses

Primary practice location

610 E Franklin St
Monroe, NC 28112-5702

Mailing address

610 E Franklin St
Monroe, NC 28112-5702
Phone (704) 289-1523

Other identifiers 3

IdentifierTypeStateIssuer
2137361OtherPK
000068587MedicaidSC
0905257MedicaidNC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210304002676 NC Part B Supplier - Mass Immunization (Roster Biller Only) 5294853958 Practice locations: Monroe, NC

National Provider Directory

National Provider Directory

Locations

610 E Franklin St
Monroe, NC 28112
Phone (704) 289-1523

Practitioners & affiliated clinicians

Practitioners 1

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": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508803200000",
    "number": "1821195751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 E FRANKLIN ST",
            "city": "MONROE",
            "state": "NC",
            "postal_code": "281125702",
            "telephone_number": "704-289-1523",
            "fax_number": "704-289-4758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 E FRANKLIN ST",
            "city": "MONROE",
            "state": "NC",
            "postal_code": "281125702",
            "telephone_number": "704-289-1523",
            "fax_number": "855-841-5354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDI-SERVICE OF CHARLOTTE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2017-10-24",
        "status": "A",
        "authorized_official_last_name": "FLEISCHMAN",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-516-2121"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NC",
            "license": "11378",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2137361",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000068587",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0905257",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2017; 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.