MEDICARE: MILRUSH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	13459	SC

General Provider Information

NPI Number	:	1215138235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILRUSH, LLC

Provider Business Mailing Address
First Line	:	503 CHESTER AVENUE
Second Line	:	SUITE A
City	:	GREAT FALLS
State	:	SC
Zip	:	29055
Country	:	US
Telephone Number	:	803-482-2249
Fax Number	:	803-482-3349

Provider Business Practice Location Address
First Line	:	503 CHESTER AVENUE
Second Line	:
City	:	GREAT FALLS
State	:	SC
Zip	:	29055
Country	:	US
Telephone Number	:	803-482-2249
Fax Number	:	803-482-3349

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MR. GARY LEE MILHORN II
Credential	:	PHARMD
Telephone Number	:	803-482-2249

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	10/19/2011

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