MEDICARE: MILLS PHARMACY AT MCCALLA INC

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	3336C0003X	Community/Retail Pharmacy	113337	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2123011	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649509225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLS PHARMACY AT MCCALLA INC

Provider Business Mailing Address
First Line	:	PO BOX 26679
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35260-0679
Country	:	US
Telephone Number	:	205-477-1007
Fax Number	:	205-477-1027

Provider Business Practice Location Address
First Line	:	4750 EASTERN VALLEY RD
Second Line	:
City	:	MC CALLA
State	:	AL
Zip	:	35111-3406
Country	:	US
Telephone Number	:	205-477-1007
Fax Number	:	205-477-1027

Authorized Official
Title or Position	:	PHARMACIST
Name	:	JOSH HARDIN
Credential	:	PHARMD
Telephone Number	:	205-680-3737

Provider Enumeration Date	:	12/10/2009
Last Update Date	:	04/10/2020

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