Provider Demographics
NPI:1659493138
Name:MCMILLAN, CLARENCE JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:
Last Name:MCMILLAN
Suffix:JR
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 1:12 N FEDERAL HWY # A
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-4305
Mailing Address - Country:US
Mailing Address - Phone:954-283-7075
Mailing Address - Fax:888-510-2297
Practice Address - Street 1:12 N FEDERAL HWY # A
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-4305
Practice Address - Country:US
Practice Address - Phone:954-283-7075
Practice Address - Fax:888-510-2297
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS352091835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS35209OtherPHARMACY LICENSE