Organization
PRESCRIPTION SHOP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NICHOLAS FRANK MILLINGTON RPH (PHARMACIST/OWNER)
(830) 583-9652
Entity
Organization
Contact information
Practice address
143 CRAIG STREET, KENEDY, TX 78119
(830) 583-9652
(830) 583-3923
Mailing address
143 CRAIG STREET, KENEDY, TX 78119
(830) 583-9652
(830) 583-3923
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
04530
TX
3336C0003X
Community/Retail Pharmacy
Primary
04530
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
141618
—
TX
Enumeration date
10/02/2006
Last updated
03/11/2009
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