Provider Demographics
NPI:1740545169
Name:MILLENIUM CORPORATION
Entity type:Organization
Organization Name:MILLENIUM CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NAVNEET
Authorized Official - Middle Name:
Authorized Official - Last Name:GREWAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-724-0224
Mailing Address - Street 1:763 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:763 S NEW BALLAS RD STE 100
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-8711
Practice Address - Country:US
Practice Address - Phone:215-968-3130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20120304813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136203OtherPK