Provider Demographics
NPI:1255601027
Name:MILLAR, MARK RICHARD (PHARMD)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:RICHARD
Last Name:MILLAR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1075 HIGHWAY 96 E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55127-2326
Mailing Address - Country:US
Mailing Address - Phone:651-426-9225
Mailing Address - Fax:651-429-4041
Practice Address - Street 1:2920 WHITE BEAR AVE N
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1304
Practice Address - Country:US
Practice Address - Phone:651-251-9938
Practice Address - Fax:651-251-9944
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115766183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist