Healthcare Provider Details

I. General information

NPI: 1306457908
Provider Name (Legal Business Name): MILLS COMPOUNDING PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1744 W MAPLE RD STE B
BIRMINGHAM MI
48009-1545
US

IV. Provider business mailing address

1744 W MAPLE RD STE B
BIRMINGHAM MI
48009-1545
US

V. Phone/Fax

Practice location:
  • Phone: 248-633-2880
  • Fax: 248-633-2881
Mailing address:
  • Phone: 248-633-2880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. PIERRE M BOUTROS
Title or Position: PHARMACY DIRECTOR
Credential: R.PH
Phone: 248-361-6868