Provider Demographics
NPI:1578855482
Name:MILLS, GREGORY DAVID (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:DAVID
Last Name:MILLS
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 1:910 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:RED LION
Mailing Address - State:PA
Mailing Address - Zip Code:17356-1952
Mailing Address - Country:US
Mailing Address - Phone:717-244-2919
Mailing Address - Fax:717-244-2821
Practice Address - Street 1:910 W BROADWAY
Practice Address - Street 2:
Practice Address - City:RED LION
Practice Address - State:PA
Practice Address - Zip Code:17356-1952
Practice Address - Country:US
Practice Address - Phone:717-244-2919
Practice Address - Fax:717-244-2821
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442755183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist