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General NPI Number Information
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NPI Number | 1689058315
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Entity Type | Individual
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Provider Name | NANCY MILLEDGE
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Gender | Female
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Dates
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Enumeration Date | 07/13/2015
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Last Update Date | 07/13/2015
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Provider Practice Location Address
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Address Line | 900 E ROSS ST
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City | CLEARWATER
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State | KS
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Zip | 67026-7849
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Country | US
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Telephone | 620-584-4044
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Fax | 620-584-4044
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Provider Business Mailing Address
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Address Line | 1809 E ELK RIDGE AVE
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City | GODDARD
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State | KS
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Zip | 67052-8551
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Country | US
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Telephone | 785-466-6810
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Fax | 620-584-4044
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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 | 11695
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License Number State | KS
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