Provider Demographics
NPI:1578844940
Name:MCMILLIN, JASON G (PHARMD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:G
Last Name:MCMILLIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 W GORDON TER APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2073
Mailing Address - Country:US
Mailing Address - Phone:773-960-2183
Mailing Address - Fax:
Practice Address - Street 1:2817 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5207
Practice Address - Country:US
Practice Address - Phone:773-327-6119
Practice Address - Fax:773-327-1893
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.294845183500000X
FLPS51590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist