Provider Demographics
NPI:1407914831
Name:MILLS PHARMACY INC
Entity Type:Organization
Organization Name:MILLS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:248-644-5060
Mailing Address - Street 1:1740 W MAPLE ROAD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009
Mailing Address - Country:US
Mailing Address - Phone:248-644-5060
Mailing Address - Fax:248-644-5576
Practice Address - Street 1:1740 W MAPLE ROAD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009
Practice Address - Country:US
Practice Address - Phone:248-644-5060
Practice Address - Fax:248-644-5576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315011943333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2305577OtherNAPB
5116820001Medicare ID - Type Unspecified