Provider Demographics
NPI:1225322985
Name:MCMILLAN, ISAAC GRANT (RPH)
Entity Type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:GRANT
Last Name:MCMILLAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:DR
Other - First Name:IKE
Other - Middle Name:G
Other - Last Name:MCMILLAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:1905 N JACKSON ST
Mailing Address - Street 2:STE 500
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-2200
Mailing Address - Country:US
Mailing Address - Phone:931-454-0482
Mailing Address - Fax:931-461-1191
Practice Address - Street 1:1905 N JACKSON ST
Practice Address - Street 2:STE 500
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-2200
Practice Address - Country:US
Practice Address - Phone:931-454-0482
Practice Address - Fax:931-461-1191
Is Sole Proprietor?:No
Enumeration Date:2011-05-30
Last Update Date:2011-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN807183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist