Healthcare Provider Details

I. General information

NPI: 1700118361
Provider Name (Legal Business Name): MILLS PHARMACY & APOTHECARY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2010
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

1744 W MAPLE RD SUITE A
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 TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301009328
License Number StateMI

VIII. Authorized Official

Name: PIERRE BOUTROS
Title or Position: PHARMACIST/OWNER
Credential: PHARMD
Phone: 248-644-5060