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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	13459	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2131882	OTHER	PK
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487682878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILRUSH LLC

Provider Business Mailing Address
First Line	:	503 CHESTER AVE
Second Line	:	SUITE A
City	:	GREAT FALLS
State	:	SC
Zip	:	29055-1207
Country	:	US
Telephone Number	:	803-482-2249
Fax Number	:	803-482-3349

Provider Business Practice Location Address
First Line	:	503 CHESTER AVE
Second Line	:	SUITE A
City	:	GREAT FALLS
State	:	SC
Zip	:	29055-1207
Country	:	US
Telephone Number	:	803-482-2249
Fax Number	:	803-482-3349

Authorized Official
Title or Position	:	PHARMD
Name	:	PETE MILHORN
Credential	:
Telephone Number	:	803-482-2249

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	10/07/2016

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Directions to “MILRUSH LLC ” Practice Location

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