Healthcare Provider Details

I. General information

NPI: 1205094992
Provider Name (Legal Business Name): JEROME D MILLS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W MAPLE RD
BIRMINGHAM MI
48009-1545
US

IV. Provider business mailing address

737 KENSINGTON LN
BLOOMFIELD HILLS MI
48304-3743
US

V. Phone/Fax

Practice location:
  • Phone: 248-644-5060
  • Fax:
Mailing address:
  • Phone: 248-540-3304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302019153
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: