Provider Demographics
NPI:1326799727
Name:MILLS, JOHN CLAY (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CLAY
Last Name:MILLS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:
Mailing Address - City:BATTLE MOUNTAIN
Mailing Address - State:NV
Mailing Address - Zip Code:89820-0548
Mailing Address - Country:US
Mailing Address - Phone:775-635-2323
Mailing Address - Fax:775-635-3213
Practice Address - Street 1:990 BROYLES RANCH RD
Practice Address - Street 2:
Practice Address - City:BATTLE MOUNTAIN
Practice Address - State:NV
Practice Address - Zip Code:89820-2633
Practice Address - Country:US
Practice Address - Phone:775-635-2323
Practice Address - Fax:775-635-3213
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV08707183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2808902Medicaid