Provider Demographics
NPI:1992032668
Name:MINTER, CRAIG (RPH)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:MINTER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 LIVE OAK ST
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:NC
Mailing Address - Zip Code:28516-8200
Mailing Address - Country:US
Mailing Address - Phone:252-728-4217
Mailing Address - Fax:252-728-1720
Practice Address - Street 1:1703 LIVE OAK ST
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:NC
Practice Address - Zip Code:28516-8200
Practice Address - Country:US
Practice Address - Phone:252-728-4217
Practice Address - Fax:252-728-1720
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2014-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036168-1183500000X
NC18823183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist