Provider Demographics
NPI:1649383217
Name:MILLS, AMANDA CRYSTAL (PHARM D)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:CRYSTAL
Last Name:MILLS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 NANTUCKET LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-2965
Mailing Address - Country:US
Mailing Address - Phone:405-285-7693
Mailing Address - Fax:
Practice Address - Street 1:7128 E RENO AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4478
Practice Address - Country:US
Practice Address - Phone:405-737-3464
Practice Address - Fax:405-737-9554
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13787183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist