=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366815649
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MILLS SPECIALTY PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2015
-----------------------------------------------------
Last Update Date | 04/13/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2400 MOUNTAIN DR STE 104 SUITE 104
-----------------------------------------------------
City | HOOVER
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35226-1569
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-871-9007
-----------------------------------------------------
Fax | 205-968-9946
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 26679
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35260-0679
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-871-9007
-----------------------------------------------------
Fax | 205-968-9946
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JOSH HARDIN
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 205-871-9007
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 114547
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------