Provider Demographics
NPI:1669730719
Name:MILLS PHARMACY AT MIDFIELD LLC
Entity type:Organization
Organization Name:MILLS PHARMACY AT MIDFIELD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:205-427-0955
Mailing Address - Street 1:PO BOX 26679
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35260-0679
Mailing Address - Country:US
Mailing Address - Phone:205-925-7000
Mailing Address - Fax:205-925-2959
Practice Address - Street 1:30A PHILLIPS DR
Practice Address - Street 2:
Practice Address - City:MIDFIELD
Practice Address - State:AL
Practice Address - Zip Code:35228-2233
Practice Address - Country:US
Practice Address - Phone:205-925-7000
Practice Address - Fax:205-925-2959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1138943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2134854OtherPK
AL1669730719Medicaid
101G640567Medicare PIN