Provider Demographics
NPI:1861857617
Name:J MILLS ENTERPRISES LLC
Entity Type:Organization
Organization Name:J MILLS ENTERPRISES LLC
Other - Org Name:OWENSBORO FAMILY PHARMACY AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, MANAGING MEMBER, AO,PIC
Authorized Official - Prefix:
Authorized Official - First Name:JESICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, MBA
Authorized Official - Phone:270-485-2150
Mailing Address - Street 1:720 W BYERS AVE
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-6330
Mailing Address - Country:US
Mailing Address - Phone:270-683-2400
Mailing Address - Fax:270-685-4825
Practice Address - Street 1:720 W BYERS AVE
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-6330
Practice Address - Country:US
Practice Address - Phone:270-683-2400
Practice Address - Fax:270-685-4825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-21
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
KYP077443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2156184OtherPK
KY7100392900Medicaid