Provider Demographics
NPI:1346525540
Name:MILLEN, JENNIFER A (RPH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:MILLEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:MI
Mailing Address - Zip Code:49021-1231
Mailing Address - Country:US
Mailing Address - Phone:269-763-9521
Mailing Address - Fax:269-763-2119
Practice Address - Street 1:117 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:MI
Practice Address - Zip Code:49021-1231
Practice Address - Country:US
Practice Address - Phone:269-763-9521
Practice Address - Fax:269-763-2119
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032321183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist