Provider Demographics
NPI:1346435351
Name:JOHN MINTER
Entity Type:Organization
Organization Name:JOHN MINTER
Other - Org Name:VALLEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-756-3092
Mailing Address - Street 1:4103 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36854-3448
Mailing Address - Country:US
Mailing Address - Phone:334-756-3092
Mailing Address - Fax:334-756-9024
Practice Address - Street 1:4103 20TH AVE
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854-3448
Practice Address - Country:US
Practice Address - Phone:334-756-3092
Practice Address - Fax:334-756-9024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL109903332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK100001389Medicaid
AS0310840001Medicare NSC