Healthcare Provider Details

I. General information

NPI: 1972843191
Provider Name (Legal Business Name): MAUREEN CHRISTINE MINOT PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2013
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W COLLEGE AVE FL 2
APPLETON WI
54911-5826
US

IV. Provider business mailing address

1518 RIVERSIDE AVE
BALTIMORE MD
21230-4625
US

V. Phone/Fax

Practice location:
  • Phone: 999-999-9999
  • Fax:
Mailing address:
  • Phone: 267-800-4951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25507
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP447241
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: