Provider Demographics
NPI:1578148151
Name:MILLS, ANGELA S
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:S
Last Name:MILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 POOL ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43605-3740
Mailing Address - Country:US
Mailing Address - Phone:419-356-5254
Mailing Address - Fax:
Practice Address - Street 1:3721 NAVARRE AVE
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3433
Practice Address - Country:US
Practice Address - Phone:419-698-5156
Practice Address - Fax:419-698-5320
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2303-5945183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician