Provider Demographics
NPI:1063011559
Name:MINGO, PHYLLIS (PHARM D)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:MINGO
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 PATEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3570
Mailing Address - Country:US
Mailing Address - Phone:864-797-0080
Mailing Address - Fax:864-797-0085
Practice Address - Street 1:175 PATEWOOD DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3570
Practice Address - Country:US
Practice Address - Phone:864-797-0080
Practice Address - Fax:864-797-0085
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9332183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist