MEDICARE: MILLENNIUM PHARMACY SYSTEMS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0004X	Compounding Pharmacy
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PW0512	OTHER	MD	STATE BOARD OF PHARMACY

General Provider Information

NPI Number	:	1356174965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLENNIUM PHARMACY SYSTEMS LLC

Provider Business Mailing Address
First Line	:	PO BOX 85096
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60689-5096
Country	:	US
Telephone Number	:	847-583-5610
Fax Number	:

Provider Business Practice Location Address
First Line	:	7100 COLUMBIA GATEWAY DR STE 100110
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21046-2140
Country	:	US
Telephone Number	:	877-791-6772
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY
Name	:	ALLISON BROWN
Credential	:
Telephone Number	:	502-630-7429

Provider Enumeration Date	:	08/21/2024
Last Update Date	:	08/21/2024

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