Provider Demographics
NPI:1033372214
Name:MINTON, JENNA ANNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:ANNE
Last Name:MINTON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 SMITH CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-4911
Mailing Address - Country:US
Mailing Address - Phone:252-537-7010
Mailing Address - Fax:252-533-0620
Practice Address - Street 1:107 SMITH CHURCH RD
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-4911
Practice Address - Country:US
Practice Address - Phone:252-537-7010
Practice Address - Fax:252-533-0620
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC19633183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist