Mintz Coastal Drug Store Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

09293 Issued in NC

Legal business name

MINTZ COASTAL DRUG STORE INC

Practice address

4802 Main Street
Shallotte, NC 28470-1863

Phone

(910) 754-6563

NPI assigned

Feb 5, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Theresa Lou Mintz

Title

President, Manager

Phone

(910) 754-6563

Specialties & licenses 1

Addresses

Other names 1

• Coastal Drug Store Former legal business name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363046400000",
    "number": "1700925898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70",
            "city": "SHALLOTTE",
            "state": "NC",
            "postal_code": "284590070",
            "telephone_number": "910-754-6563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4802 MAIN STREET",
            "city": "SHALLOTTE",
            "state": "NC",
            "postal_code": "284701863",
            "telephone_number": "910-754-6563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINTZ COASTAL DRUG STORE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-05",
        "last_updated": "2013-03-12",
        "status": "A",
        "authorized_official_last_name": "MINTZ",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "LOU",
        "authorized_official_title_or_position": "PRESIDENT, MANAGER",
        "authorized_official_telephone_number": "910-754-6563",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NC",
            "license": "09293",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Drug Store",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Community/Retail Pharmacy in Shallotte, NC
• Providers in Shallotte, NC by specialty
• Community/Retail Pharmacy in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.