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General NPI Number Information
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NPI Number | 1578844940
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Entity Type | Individual
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Provider Name | JASON G MCMILLIN PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 08/30/2011
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Last Update Date | 04/24/2014
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Provider Practice Location Address
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Address Line | 2817 N CLARK ST
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City | CHICAGO
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State | IL
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Zip | 60657-5207
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Country | US
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Telephone | 773-327-6119
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Fax | 773-327-1893
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Provider Business Mailing Address
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Address Line | 918 W GORDON TER APT 3
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City | CHICAGO
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State | IL
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Zip | 60613-2073
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Country | US
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Telephone | 773-960-2183
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051.294845
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS51590
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License Number State | FL
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