Provider Demographics
NPI:1487167821
Name:MILLS PRICE, MARY AGNES
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:AGNES
Last Name:MILLS PRICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:684 COUNTY HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:OH
Mailing Address - Zip Code:43944-6904
Mailing Address - Country:US
Mailing Address - Phone:740-765-5309
Mailing Address - Fax:
Practice Address - Street 1:220 3RD ST
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43968-1660
Practice Address - Country:US
Practice Address - Phone:330-532-5889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0004898183500000X
OH03316929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist