Healthcare Provider Details

I. General information

NPI: 1396178141
Provider Name (Legal Business Name): SHAWN GLEN MILLS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N MAIN ST
RITTMAN OH
44270-1580
US

IV. Provider business mailing address

6178 STONEY RIDGE RD
NORTH RIDGEVILLE OH
44039-1217
US

V. Phone/Fax

Practice location:
  • Phone: 330-925-6015
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03131887
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: