Provider Demographics
NPI:1063822872
Name:ANTHONY MARTIN MILLS, M.D., PHARMACY INC.
Entity Type:Organization
Organization Name:ANTHONY MARTIN MILLS, M.D., PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-550-1010
Mailing Address - Street 1:9201 W SUNSET BLVD STE 812
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90069-3709
Mailing Address - Country:US
Mailing Address - Phone:310-550-1010
Mailing Address - Fax:
Practice Address - Street 1:9201 W SUNSET BLVD STE 812
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90069-3709
Practice Address - Country:US
Practice Address - Phone:310-550-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy