Provider Demographics
NPI:1538458823
Name:MILLIKAN, JEAN ELIZABETH (RPH)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:ELIZABETH
Last Name:MILLIKAN
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 1:8176 NORMANDY RD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-8644
Mailing Address - Country:US
Mailing Address - Phone:704-489-8691
Mailing Address - Fax:
Practice Address - Street 1:316 S TRYON ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-1914
Practice Address - Country:US
Practice Address - Phone:704-377-0215
Practice Address - Fax:704-344-1518
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13207183500000X
WI8839-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist