Provider Demographics
NPI:1215084389
Name:MILLAN, WILMET I (PHARMACIST)
Entity type:Individual
Prefix:MRS
First Name:WILMET
Middle Name:I
Last Name:MILLAN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:MRS
Other - First Name:WILMET
Other - Middle Name:I
Other - Last Name:MILLAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:CRISTOBAL COLON #25
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767
Mailing Address - Country:US
Mailing Address - Phone:787-893-1210
Mailing Address - Fax:787-893-2577
Practice Address - Street 1:CRISTOBAL COLON #25
Practice Address - Street 2:
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767
Practice Address - Country:US
Practice Address - Phone:787-893-1210
Practice Address - Fax:787-893-2577
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4411183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4411OtherLICENSE NUMBER