MEDICARE: JASON G MCMILLIN PHARM.D.

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	183500000X	Pharmacist	051.294845	IL
2	183500000X	Pharmacist	PS51590	FL

General Provider Information

NPI Number	:	1578844940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON G MCMILLIN PHARM.D.

Provider Business Mailing Address
First Line	:	918 W GORDON TER APT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-2073
Country	:	US
Telephone Number	:	773-960-2183
Fax Number	:

Provider Business Practice Location Address
First Line	:	2817 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5207
Country	:	US
Telephone Number	:	773-327-6119
Fax Number	:	773-327-1893

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2011
Last Update Date	:	04/24/2014

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