Provider Demographics
NPI:1164709754
Name:MINDER, NICOLE LEE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:LEE
Last Name:MINDER
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 1:15 HAMILTONS BAY CT
Mailing Address - Street 2:APT. 911
Mailing Address - City:LAKE WYLIE
Mailing Address - State:SC
Mailing Address - Zip Code:29710-6049
Mailing Address - Country:US
Mailing Address - Phone:856-981-2597
Mailing Address - Fax:
Practice Address - Street 1:16035 JOHNSTON RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2566
Practice Address - Country:US
Practice Address - Phone:704-542-5132
Practice Address - Fax:704-542-5368
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22047183500000X
SC13478183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist