Provider Demographics
NPI:1043620479
Name:MILLINGTON PHARMACY LLC
Entity Type:Organization
Organization Name:MILLINGTON PHARMACY LLC
Other - Org Name:MILLINGTON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DUESBOUT
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:989-871-2820
Mailing Address - Street 1:PO BOX 440
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48746
Mailing Address - Country:US
Mailing Address - Phone:989-871-2820
Mailing Address - Fax:989-871-2823
Practice Address - Street 1:8542 STATE RD
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:MI
Practice Address - Zip Code:48746-9446
Practice Address - Country:US
Practice Address - Phone:989-871-2820
Practice Address - Fax:989-871-2823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7365250001OtherPTAN