Provider Demographics
NPI:1952002180
Name:MILLS, KRISTIN LEE
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LEE
Last Name:MILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-2469
Mailing Address - Country:US
Mailing Address - Phone:805-474-0469
Mailing Address - Fax:805-474-9436
Practice Address - Street 1:559 KINGS AVE
Practice Address - Street 2:
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442-2618
Practice Address - Country:US
Practice Address - Phone:805-550-8603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician