Provider Demographics
NPI:1639620909
Name:MINES, KATHERINE EASTERLING (PHARMD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:EASTERLING
Last Name:MINES
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 1:2459 JOSHUA LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-7610
Mailing Address - Country:US
Mailing Address - Phone:910-894-2817
Mailing Address - Fax:
Practice Address - Street 1:3601 REYNOLDA RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-2229
Practice Address - Country:US
Practice Address - Phone:336-924-9366
Practice Address - Fax:336-924-5345
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26572183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist