Provider Demographics
NPI:1568795268
Name:MINTON, PENNY (RPH)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:MINTON
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 1:109 MARKET PLACE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-3152
Mailing Address - Country:US
Mailing Address - Phone:336-818-3059
Mailing Address - Fax:336-818-3219
Practice Address - Street 1:109 MARKET PLACE DR
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3152
Practice Address - Country:US
Practice Address - Phone:336-818-3059
Practice Address - Fax:336-818-3219
Is Sole Proprietor?:No
Enumeration Date:2009-09-12
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12299183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist