Provider Demographics
NPI:1942767165
Name:MILLIS, TIMMIE GEORGE JR (RPH)
Entity Type:Individual
Prefix:
First Name:TIMMIE
Middle Name:GEORGE
Last Name:MILLIS
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 CARRIAGE TRL
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75072-4306
Mailing Address - Country:US
Mailing Address - Phone:214-649-6874
Mailing Address - Fax:
Practice Address - Street 1:112 HALL RD
Practice Address - Street 2:
Practice Address - City:SEAGOVILLE
Practice Address - State:TX
Practice Address - Zip Code:75159-2916
Practice Address - Country:US
Practice Address - Phone:972-287-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-24
Last Update Date:2019-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist