Healthcare Provider Details

I. General information

NPI: 1639620909
Provider Name (Legal Business Name): KATHERINE EASTERLING MINES PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 REYNOLDA RD
WINSTON SALEM NC
27106-2229
US

IV. Provider business mailing address

2459 JOSHUA LN
WINSTON SALEM NC
27127-7610
US

V. Phone/Fax

Practice location:
  • Phone: 336-924-9366
  • Fax: 336-924-5345
Mailing address:
  • Phone: 910-894-2817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26572
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: