MEDICARE: PENNY MINTON R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	12299	NC

General Provider Information

NPI Number	:	1568795268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PENNY MINTON R.PH.

Provider Business Mailing Address
First Line	:	109 MARKET PLACE DR
Second Line	:
City	:	NORTH WILKESBORO
State	:	NC
Zip	:	28659-3152
Country	:	US
Telephone Number	:	336-818-3059
Fax Number	:	336-818-3219

Provider Business Practice Location Address
First Line	:	109 MARKET PLACE DR
Second Line	:
City	:	NORTH WILKESBORO
State	:	NC
Zip	:	28659-3152
Country	:	US
Telephone Number	:	336-818-3059
Fax Number	:	336-818-3219

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2009
Last Update Date	:	12/23/2022

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Directions to “ PENNY MINTON R.PH.” Practice Location

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