MEDICARE: DR. KATHLEEN S. MCMILLAN 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	5302034130	MI

General Provider Information

NPI Number	:	1902190283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN S. MCMILLAN PHARMD

Provider Business Mailing Address
First Line	:	334 CHICAGO DR
Second Line	:
City	:	JENISON
State	:	MI
Zip	:	49428-9244
Country	:	US
Telephone Number	:	616-457-2730
Fax Number	:	616-457-2730

Provider Business Practice Location Address
First Line	:	334 CHICAGO DR
Second Line	:
City	:	JENISON
State	:	MI
Zip	:	49428-9244
Country	:	US
Telephone Number	:	616-457-2730
Fax Number	:	616-457-2730

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

Provider Enumeration Date	:	06/04/2011
Last Update Date	:	06/04/2011

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Directions to “ DR. KATHLEEN S. MCMILLAN PHARMD” Practice Location

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