=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457567513
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBRA L MILLIGAN PHARMACIST
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2007
-----------------------------------------------------
Last Update Date | 04/21/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 815 HAZELWEST DR STE 100
-----------------------------------------------------
City | HAZELWOOD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63042-1762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-895-3300
-----------------------------------------------------
Fax | 314-451-8585
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7025 HOWDERSHELL RD SUITE K
-----------------------------------------------------
City | HAZELWOOD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63042-3811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-895-3300
-----------------------------------------------------
Fax | 314-895-3216
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 041073
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------