Provider Demographics
NPI:1457567513
Name:MILLIGAN, DEBRA L (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:MILLIGAN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7025 HOWDERSHELL RD
Mailing Address - Street 2:SUITE K
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-3811
Mailing Address - Country:US
Mailing Address - Phone:314-895-3300
Mailing Address - Fax:314-895-3216
Practice Address - Street 1:815 HAZELWEST DR STE 100
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-1762
Practice Address - Country:US
Practice Address - Phone:314-895-3300
Practice Address - Fax:314-451-8585
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO041073183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO606786705Medicaid