Healthcare Provider Details

I. General information

NPI: 1407095557
Provider Name (Legal Business Name): KYLE A. MILLS PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2965 NE CONNERS AVE SUITE 280
BEND OR
97701-7753
US

IV. Provider business mailing address

600 SW COLUMBIA ST SUITE 6150
BEND OR
97702-1099
US

V. Phone/Fax

Practice location:
  • Phone: 541-323-4269
  • Fax: 541-383-1883
Mailing address:
  • Phone: 541-323-3181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH-0011772
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: