Basic Information
| Provider Information | |||||||||
| NPI: | 1457952566 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCMILLAN | ||||||||
| FirstName: | ALICIA | ||||||||
| MiddleName: | WYNETT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARM.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11215 GEORGIA AVE APT 1606 | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209027668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8507122141 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2399 N POINT BLVD | ||||||||
| Address2: | |||||||||
| City: | DUNDALK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212221623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102840126 | ||||||||
| FaxNumber: | 4102840469 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2020 | ||||||||
| LastUpdateDate: | 11/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 26527 | MD | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.