Provider Demographics
NPI:1104133651
Name:MCINTOSH, MISTY LAIL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MISTY
Middle Name:LAIL
Last Name:MCINTOSH
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 1:427 N GENERALS BLVD
Mailing Address - Street 2:PHARMACY DEPARTMENT
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-3559
Mailing Address - Country:US
Mailing Address - Phone:704-732-7380
Mailing Address - Fax:704-732-7380
Practice Address - Street 1:427 N GENERALS BLVD
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-3559
Practice Address - Country:US
Practice Address - Phone:704-732-7380
Practice Address - Fax:704-732-7380
Is Sole Proprietor?:No
Enumeration Date:2010-09-04
Last Update Date:2010-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18265183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist