Provider Demographics
NPI:1659984375
Name:MILLS, RUSSELL GARRETT
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:GARRETT
Last Name:MILLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4634 N HIGHWAY 7
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71909-9410
Mailing Address - Country:US
Mailing Address - Phone:501-984-4151
Mailing Address - Fax:501-984-5325
Practice Address - Street 1:4634 N HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71909-9410
Practice Address - Country:US
Practice Address - Phone:501-984-4151
Practice Address - Fax:501-984-5325
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD15238183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist