Provider Demographics
NPI:1972103794
Name:MILLIK, STEPHAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:STEPHAN
Middle Name:
Last Name:MILLIK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5548 NETTLECREEK AVE NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-9528
Mailing Address - Country:US
Mailing Address - Phone:330-881-0482
Mailing Address - Fax:
Practice Address - Street 1:231 BLUEBELL DR N.W.
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663
Practice Address - Country:US
Practice Address - Phone:330-339-6163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03334614183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist