Provider Demographics
NPI:1417179219
Name:MILLMAN, LORA LYNNE (RPH)
Entity Type:Individual
Prefix:MS
First Name:LORA
Middle Name:LYNNE
Last Name:MILLMAN
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 1:1005 HILLDALE LN
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-7017
Mailing Address - Country:US
Mailing Address - Phone:847-541-8803
Mailing Address - Fax:
Practice Address - Street 1:825 S WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-2696
Practice Address - Country:US
Practice Address - Phone:847-735-8045
Practice Address - Fax:847-735-8046
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-034502183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist