Provider Demographics
NPI:1497108625
Name:GADDY, JONATHAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:GADDY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 S SHARON AMITY RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2802
Mailing Address - Country:US
Mailing Address - Phone:704-366-5684
Mailing Address - Fax:704-366-1598
Practice Address - Street 1:112 S SHARON AMITY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2802
Practice Address - Country:US
Practice Address - Phone:704-366-5684
Practice Address - Fax:704-366-1598
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-23
Last Update Date:2016-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15937183500000X
SC12325183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1518259613OtherNPI