Provider Demographics
NPI:1447412036
Name:MILLS, DEVONA JO (PHARMD)
Entity Type:Individual
Prefix:
First Name:DEVONA
Middle Name:JO
Last Name:MILLS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3735 PALOMAR CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1147
Mailing Address - Country:US
Mailing Address - Phone:859-223-0701
Mailing Address - Fax:859-223-0502
Practice Address - Street 1:3735 PALOMAR CENTRE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1147
Practice Address - Country:US
Practice Address - Phone:859-223-0701
Practice Address - Fax:859-223-0502
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10962183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist