Provider Demographics
NPI:1851703169
Name:MCMILLIN, TARA RACHELLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:RACHELLE
Last Name:MCMILLIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:RACHELLE
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2425 ALPINE AVE NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49544-1956
Mailing Address - Country:US
Mailing Address - Phone:616-363-9849
Mailing Address - Fax:616-365-6065
Practice Address - Street 1:2425 ALPINE AVE NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544-1956
Practice Address - Country:US
Practice Address - Phone:616-363-9849
Practice Address - Fax:616-365-6065
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302039140183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist