Provider Demographics
NPI:1992952725
Name:MILLIRON, JACOB R (PHARM D)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:R
Last Name:MILLIRON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47450 SAINT ANDREWS CT
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-5943
Mailing Address - Country:US
Mailing Address - Phone:907-283-8001
Mailing Address - Fax:
Practice Address - Street 1:299 N BINKLEY ST
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7523
Practice Address - Country:US
Practice Address - Phone:907-262-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1655183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist