Provider Demographics
NPI:1427423060
Name:MILLS, JESICA THOMASON (PHARMD, MBA, RPH)
Entity type:Individual
Prefix:DR
First Name:JESICA
Middle Name:THOMASON
Last Name:MILLS
Suffix:
Gender:F
Credentials:PHARMD, MBA, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 VALLEYVIEW CT
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-2748
Mailing Address - Country:US
Mailing Address - Phone:270-485-2150
Mailing Address - Fax:270-685-4825
Practice Address - Street 1:720 W BYERS AVE
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-6330
Practice Address - Country:US
Practice Address - Phone:270-683-2400
Practice Address - Fax:270-685-4825
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0173061835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy