Provider Demographics
NPI:1487971776
Name:MILLIREN, JAMINIQUE (PHARM D)
Entity type:Individual
Prefix:
First Name:JAMINIQUE
Middle Name:
Last Name:MILLIREN
Suffix:
Gender:F
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 1:1001 OAKDALE RD
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15071-1502
Mailing Address - Country:US
Mailing Address - Phone:412-438-5117
Mailing Address - Fax:
Practice Address - Street 1:1001 OAKDALE RD
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:PA
Practice Address - Zip Code:15071-1502
Practice Address - Country:US
Practice Address - Phone:412-438-5117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442665183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP442665OtherSTATE LICENSE