Provider Demographics
NPI:1558562728
Name:MILLS, KEVIN D (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:D
Last Name:MILLS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:6466 TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-6542
Mailing Address - Country:US
Mailing Address - Phone:716-646-6632
Mailing Address - Fax:716-690-2532
Practice Address - Street 1:445 TREMONT ST
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-6150
Practice Address - Country:US
Practice Address - Phone:716-690-2234
Practice Address - Fax:716-690-2582
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048458-11835G0303X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1835G0303XPharmacy Service ProvidersPharmacistGeriatric
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY048458-1OtherLISCENSE NUMBER