Provider Demographics
NPI:1104123991
Name:MINTA, MICHAEL OSEI
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:OSEI
Last Name:MINTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12334 HAMPTON PLACE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-5233
Mailing Address - Country:US
Mailing Address - Phone:704-488-8331
Mailing Address - Fax:
Practice Address - Street 1:12334 HAMPTON PLACE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-5233
Practice Address - Country:US
Practice Address - Phone:704-488-8331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18164183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist