Provider Demographics
NPI:1225310618
Name:MILLS, AUDREY JEAN
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:JEAN
Last Name:MILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 MANATEE AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-1721
Mailing Address - Country:US
Mailing Address - Phone:941-749-1561
Mailing Address - Fax:941-746-1083
Practice Address - Street 1:4220 MANATEE AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-1721
Practice Address - Country:US
Practice Address - Phone:941-749-1561
Practice Address - Fax:941-746-1083
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS21204183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist