Provider Demographics
NPI:1073883740
Name:MILNER, MICHAEL JAY (RPH, JD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JAY
Last Name:MILNER
Suffix:
Gender:M
Credentials:RPH, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7373 BOSTON BLVD
Mailing Address - Street 2:PHARMACY
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-1926
Mailing Address - Country:US
Mailing Address - Phone:703-249-0011
Mailing Address - Fax:
Practice Address - Street 1:7373 BOSTON BLVD
Practice Address - Street 2:PHARMACY
Practice Address - City:FAIRFAX STATION
Practice Address - State:VA
Practice Address - Zip Code:22039-1926
Practice Address - Country:US
Practice Address - Phone:703-249-0011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011615183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist