Provider Demographics
NPI:1972888485
Name:MILLIS, TRICIA D (PHARMD)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:D
Last Name:MILLIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4951 ROE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROELAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66205-1109
Mailing Address - Country:US
Mailing Address - Phone:913-236-6978
Mailing Address - Fax:913-236-5392
Practice Address - Street 1:4951 ROE BLVD
Practice Address - Street 2:
Practice Address - City:ROELAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66205-1109
Practice Address - Country:US
Practice Address - Phone:913-236-6978
Practice Address - Fax:913-236-5392
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-15
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-13587183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist