Healthcare Provider Details

I. General information

NPI: 1952002180
Provider Name (Legal Business Name): KRISTIN LEE MILLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 KINGS AVE
MORRO BAY CA
93442-2618
US

IV. Provider business mailing address

1690 E GRAND AVE
ARROYO GRANDE CA
93420-2469
US

V. Phone/Fax

Practice location:
  • Phone: 805-550-8603
  • Fax:
Mailing address:
  • Phone: 805-474-0469
  • Fax: 805-474-9436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: