Provider Demographics
NPI:1265577795
Name:MCMILLAN, JAMES M (CRPH)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:M
Last Name:MCMILLAN
Suffix:
Gender:M
Credentials:CRPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12826 129TH RD
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32060-6675
Mailing Address - Country:US
Mailing Address - Phone:386-362-2451
Mailing Address - Fax:
Practice Address - Street 1:911 PINEWOOD DR SW
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-4004
Practice Address - Country:US
Practice Address - Phone:386-362-6354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30870183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS30870OtherFLORIDA RPH
FLPU5559OtherFLORIDA CRPH