Provider Demographics
NPI:1346775061
Name:MINNER, KRISTIE G (RPH)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:G
Last Name:MINNER
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 1:1045 US HIGHWAY 42 SW
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-9335
Mailing Address - Country:US
Mailing Address - Phone:740-852-6145
Mailing Address - Fax:
Practice Address - Street 1:1045 US HIGHWAY 42 SW
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-9335
Practice Address - Country:US
Practice Address - Phone:740-852-6145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03221327183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist