Provider Demographics
NPI:1639404759
Name:MILLS, JODY SUE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:SUE
Last Name:MILLS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:SUE
Other - Last Name:PEARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2275 PIMA DR S
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5040
Mailing Address - Country:US
Mailing Address - Phone:909-855-2450
Mailing Address - Fax:928-453-0926
Practice Address - Street 1:129 CLEARWATER WAY
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-1754
Practice Address - Country:US
Practice Address - Phone:909-855-2450
Practice Address - Fax:928-453-0926
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47598183500000X, 1835G0303X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy