Provider Demographics
NPI:1811538960
Name:MILLS, BRIAN SYME
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:SYME
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 1:4275 HARRISON BLVD
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-3101
Mailing Address - Country:US
Mailing Address - Phone:801-479-0700
Mailing Address - Fax:801-479-1319
Practice Address - Street 1:4275 HARRISON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3101
Practice Address - Country:US
Practice Address - Phone:801-479-0700
Practice Address - Fax:801-479-1319
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT132603-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist