Provider Demographics
NPI:1518638790
Name:MILLS, JADE ALEXIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:ALEXIA
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 1:517 WRIGHT RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-8777
Mailing Address - Country:US
Mailing Address - Phone:252-678-3982
Mailing Address - Fax:
Practice Address - Street 1:204 EVANS RD
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:NC
Practice Address - Zip Code:27844-9247
Practice Address - Country:US
Practice Address - Phone:252-536-5886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30872183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist