Provider Demographics
NPI:1033628482
Name:MILLS, MATTHEW
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:MILLS
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:MATTHEW
Other - Middle Name:ROBERT
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARM D
Mailing Address - Street 1:PO BOX 1049
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59403-1049
Mailing Address - Country:US
Mailing Address - Phone:406-750-6472
Mailing Address - Fax:406-604-0597
Practice Address - Street 1:900 13TH AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4426
Practice Address - Country:US
Practice Address - Phone:406-315-1989
Practice Address - Fax:406-315-1988
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5417183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist