Provider Demographics
NPI:1508382029
Name:MINTZ, SOMMER NORRIS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SOMMER
Middle Name:NORRIS
Last Name:MINTZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 MARYPORT DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29575-6513
Mailing Address - Country:US
Mailing Address - Phone:843-450-8444
Mailing Address - Fax:
Practice Address - Street 1:125 MARYPORT DR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-6513
Practice Address - Country:US
Practice Address - Phone:843-450-8444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37121183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist