Healthcare Provider Details

I. General information

NPI: 1407914831
Provider Name (Legal Business Name): MILLS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W MAPLE ROAD
BIRMINGHAM MI
48009
US

IV. Provider business mailing address

1740 W MAPLE ROAD
BIRMINGHAM MI
48009
US

V. Phone/Fax

Practice location:
  • Phone: 248-644-5060
  • Fax: 248-644-5576
Mailing address:
  • Phone: 248-644-5060
  • Fax: 248-644-5576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5315011943
License Number StateMI

VIII. Authorized Official

Name: BARBARA R GOLDBERG
Title or Position: HEAD PHARMACIST
Credential: RPH
Phone: 248-644-5060