Healthcare Provider Details

I. General information

NPI: 1043762982
Provider Name (Legal Business Name): SHERRI MILLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 MICHIGAN AVE
OROFINO ID
83544
US

IV. Provider business mailing address

229 BEAR DANCE LANE
OROFINO ID
83544
US

V. Phone/Fax

Practice location:
  • Phone: 208-476-5727
  • Fax:
Mailing address:
  • Phone: 208-400-0842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberP7219
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: