Provider Demographics
NPI:1629166830
Name:MILLS PHARMACY AT BLUFF PARK INC
Entity Type:Organization
Organization Name:MILLS PHARMACY AT BLUFF PARK INC
Other - Org Name:ROBERT'S DISCOUNT PHARMACY, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:205-427-0955
Mailing Address - Street 1:PO BOX 26679
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35260-0679
Mailing Address - Country:US
Mailing Address - Phone:205-871-9007
Mailing Address - Fax:205-874-9946
Practice Address - Street 1:2148 TYLER RD
Practice Address - Street 2:STE 100
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35226-1513
Practice Address - Country:US
Practice Address - Phone:205-823-9500
Practice Address - Fax:205-823-0097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AL1121033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100003300Medicaid
1995031OtherPK
102G878472Medicare PIN