Provider Demographics
NPI:1447901921
Name:MINTZ, AMANDA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:MINTZ
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 1:6652 TIDEWATER LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-3630
Mailing Address - Country:US
Mailing Address - Phone:919-763-4185
Mailing Address - Fax:
Practice Address - Street 1:6652 TIDEWATER LN
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-3630
Practice Address - Country:US
Practice Address - Phone:919-763-4185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-16
Last Update Date:2022-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29854183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist