Provider Demographics
NPI:1346348653
Name:MILLS, JACK HAROLD SR (RPH)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:HAROLD
Last Name:MILLS
Suffix:SR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 232
Mailing Address - Street 2:5111 MILLS RD.
Mailing Address - City:DONALSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:39845-0232
Mailing Address - Country:US
Mailing Address - Phone:229-524-2313
Mailing Address - Fax:229-524-1202
Practice Address - Street 1:803 N WILEY AVE
Practice Address - Street 2:
Practice Address - City:DONALSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:39845-1121
Practice Address - Country:US
Practice Address - Phone:229-524-2313
Practice Address - Fax:229-524-1202
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA009642183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist