Provider Demographics
NPI:1073062063
Name:ABNEY, MINDI (RPH)
Entity Type:Individual
Prefix:
First Name:MINDI
Middle Name:
Last Name:ABNEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 SALLY HOLLER RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946-5667
Mailing Address - Country:US
Mailing Address - Phone:618-926-4415
Mailing Address - Fax:
Practice Address - Street 1:890 SALLY HOLLER RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:IL
Practice Address - Zip Code:62946-5667
Practice Address - Country:US
Practice Address - Phone:618-926-4415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-02
Last Update Date:2016-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051287807183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist