Provider Demographics
NPI:1851350367
Name:MILLS PHARMACY
Entity Type:Organization
Organization Name:MILLS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPH/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:775-635-2323
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:990 BROYLES RANCH ROAD
Mailing Address - City:BATTLE MOUNTAIN
Mailing Address - State:NV
Mailing Address - Zip Code:89820-0548
Mailing Address - Country:US
Mailing Address - Phone:775-635-2323
Mailing Address - Fax:775-635-3213
Practice Address - Street 1:990 BROYLES RANCH RD
Practice Address - Street 2:990 BROYLES RANCH ROAD
Practice Address - City:BATTLE MOUNTAIN
Practice Address - State:NV
Practice Address - Zip Code:89820-2633
Practice Address - Country:US
Practice Address - Phone:775-635-2323
Practice Address - Fax:775-635-3213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPH01220333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2808902Medicaid