Provider Demographics
NPI:1548563943
Name:MCMILLIAN, SARAH WILLETTE (RPH)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:WILLETTE
Last Name:MCMILLIAN
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 1:2795 LEWISVILLE CLEMMONS RD
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8715
Mailing Address - Country:US
Mailing Address - Phone:336-778-2452
Mailing Address - Fax:336-778-2476
Practice Address - Street 1:2795 LEWISVILLE CLEMMONS RD
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8715
Practice Address - Country:US
Practice Address - Phone:336-778-2452
Practice Address - Fax:336-778-2476
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC07910183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0347264Medicaid
NC0347264Medicaid