Provider Demographics
NPI:1679240949
Name:MILLIEN, FREUSTZA BERTHE (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:FREUSTZA
Middle Name:BERTHE
Last Name:MILLIEN
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 FENWICK FARMS DR
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241-5572
Mailing Address - Country:US
Mailing Address - Phone:786-395-5643
Mailing Address - Fax:
Practice Address - Street 1:280 FENWICK FARMS DR
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-5572
Practice Address - Country:US
Practice Address - Phone:786-395-5643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS62985183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist