Provider Demographics
NPI:1891058152
Name:MILLS PHARMACY AT PLEASANT GROVE LLC
Entity Type:Organization
Organization Name:MILLS PHARMACY AT PLEASANT GROVE LLC
Other - Org Name:MILLS PHARMACY AT PLEASANT GROVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:205-427-0955
Mailing Address - Street 1:PO BOX 26679
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35260-0679
Mailing Address - Country:US
Mailing Address - Phone:205-871-9007
Mailing Address - Fax:205-874-9946
Practice Address - Street 1:847 PARK RD STE A
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:AL
Practice Address - Zip Code:35127-1676
Practice Address - Country:US
Practice Address - Phone:205-744-0447
Practice Address - Fax:205-744-0477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-21
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1139273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL150210Medicaid
2135653OtherPK