Healthcare Provider Details

I. General information

NPI: 1770575086
Provider Name (Legal Business Name): PATRICIA L MCMILLEN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 JOHNSON FERRY RD NE
ATLANTA GA
30342-1606
US

IV. Provider business mailing address

2966 NUPTIAL LN
LAWRENCEVILLE GA
30044-2623
US

V. Phone/Fax

Practice location:
  • Phone: 404-851-8902
  • Fax:
Mailing address:
  • Phone: 770-381-9737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number013851
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS14838
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP028269L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: