Provider Demographics
NPI:1225604309
Name:MACMILLAN, CHERRIE
Entity Type:Individual
Prefix:
First Name:CHERRIE
Middle Name:
Last Name:MACMILLAN
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 1:21592 HIGH COUNTRY DR
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-3470
Mailing Address - Country:US
Mailing Address - Phone:949-500-0352
Mailing Address - Fax:
Practice Address - Street 1:21592 HIGH COUNTRY DR
Practice Address - Street 2:
Practice Address - City:TRABUCO CANYON
Practice Address - State:CA
Practice Address - Zip Code:92679-3470
Practice Address - Country:US
Practice Address - Phone:949-500-0352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-31
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0017834183500000X
CA04322183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist