MEDICARE: DR. LINDA LOUISE MACMILLAN PHARMD

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	11759	NV
2	183500000X	Pharmacist	45789	CA

General Provider Information

NPI Number	:	1609112531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA LOUISE MACMILLAN PHARMD

Provider Business Mailing Address
First Line	:	1945 LAS VEGAS BLVD S
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-1310
Country	:	US
Telephone Number	:	702-650-4417
Fax Number	:	702-369-5940

Provider Business Practice Location Address
First Line	:	1945 LAS VEGAS BLVD S
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-1310
Country	:	US
Telephone Number	:	702-650-4417
Fax Number	:	702-369-5940

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

Provider Enumeration Date	:	12/20/2012
Last Update Date	:	12/20/2012

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