Healthcare Provider Details

I. General information

NPI: 1689685190
Provider Name (Legal Business Name): MILLS PHARMACY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E MAIN ST
ANTHON IA
51004-7724
US

IV. Provider business mailing address

120 E MAIN ST
ANTHON IA
51004-7724
US

V. Phone/Fax

Practice location:
  • Phone: 712-373-5256
  • Fax: 712-373-5716
Mailing address:
  • Phone: 712-373-5256
  • Fax: 712-373-5716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number244
License Number StateIA

VIII. Authorized Official

Name: FLOYD BOYER
Title or Position: PRESIDENT
Credential: RPH
Phone: 712-373-5256