Provider Demographics
NPI:1144731431
Name:MINT HILL PHARMACY LLC
Entity type:Organization
Organization Name:MINT HILL PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:L
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:
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:2017-10-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13104333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13104OtherNORTH CAROLINA BOARD OF PHARMACY PERMIT
NC13104OtherNORTH CAROLINA BOARD OF PHARMACY PERMIT