Provider Demographics
NPI:1982984522
Name:MACMILLAN, JOEL T (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:T
Last Name:MACMILLAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 NORTHPORT DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-3025
Mailing Address - Country:US
Mailing Address - Phone:608-241-7001
Mailing Address - Fax:608-241-0539
Practice Address - Street 1:1725 NORTHPORT DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3025
Practice Address - Country:US
Practice Address - Phone:608-241-7001
Practice Address - Fax:608-241-0539
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14123183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist