Healthcare Provider Details

I. General information

NPI: 1972826311
Provider Name (Legal Business Name): BRIAN A MILLIKIN PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2010
Last Update Date: 08/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7950 CRAFT GOODMAN FRONTAGE ROAD
OLIVE BRANCH MS
38654
US

IV. Provider business mailing address

7950 CRAFT GOODMAN FRONTAGE ROAD
OLIVE BRANCH MS
38654
US

V. Phone/Fax

Practice location:
  • Phone: 662-890-5868
  • Fax:
Mailing address:
  • Phone: 662-890-5868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number33708
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number010555
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: