Provider Demographics
NPI:1386973568
Name:MILLENNIUM PHYSICIANS ASSOCIATION PLLC
Entity type:Organization
Organization Name:MILLENNIUM PHYSICIANS ASSOCIATION PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:DEL
Authorized Official - Middle Name:
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, RPH
Authorized Official - Phone:281-298-1129
Mailing Address - Street 1:22710 PROFESSIONAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-6008
Mailing Address - Country:US
Mailing Address - Phone:281-298-1129
Mailing Address - Fax:281-298-1168
Practice Address - Street 1:9319 PINECROFT DR STE 110
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3485
Practice Address - Country:US
Practice Address - Phone:281-298-1129
Practice Address - Fax:281-298-1168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
TX267233336S0011X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146280Medicaid
2123733OtherPK