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General NPI Number Information
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NPI Number | 1306457908
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Entity Type | Organization
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Legal Business Name | MILLS COMPOUNDING PHARMACY, LLC
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Dates
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Enumeration Date | 08/17/2020
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Last Update Date | 08/17/2020
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Provider Practice Location Address
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Address Line | 1744 W MAPLE RD STE B
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City | BIRMINGHAM
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State | MI
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Zip | 48009-1545
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Country | US
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Telephone | 248-633-2880
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Fax | 248-633-2881
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Provider Business Mailing Address
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Address Line | 1744 W MAPLE RD STE B
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City | BIRMINGHAM
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State | MI
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Zip | 48009-1545
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Country | US
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Telephone | 248-633-2880
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Fax |
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Authorized Official
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Title or Position | PHARMACY DIRECTOR
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Name | MR. PIERRE M BOUTROS
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Credential | R.PH
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Telephone | 248-361-6868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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