Provider Demographics
NPI:1558374728
Name:MILLS, TIMOTHY D (DPH)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:D
Last Name:MILLS
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74821-0637
Mailing Address - Country:US
Mailing Address - Phone:580-332-6639
Mailing Address - Fax:
Practice Address - Street 1:1000 ROLLING HILLS LN
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-9415
Practice Address - Country:US
Practice Address - Phone:580-436-3600
Practice Address - Fax:580-436-3958
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11626183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist