Provider Demographics
NPI:1053855510
Name:MINT HILL PHARMACY LLC
Entity Type:Organization
Organization Name:MINT HILL PHARMACY LLC
Other - Org Name:MINT HILL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:704-910-2718
Mailing Address - Street 1:7200 MATTHEWS MINT HILL RD
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-7593
Mailing Address - Country:US
Mailing Address - Phone:704-910-2718
Mailing Address - Fax:704-910-6441
Practice Address - Street 1:7200 MATTHEWS MINT HILL RD
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-7593
Practice Address - Country:US
Practice Address - Phone:704-910-2718
Practice Address - Fax:704-910-6441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-18
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166741OtherPK
NC1053855510Medicaid