Provider Demographics
NPI:1811381023
Name:MILLS, CLINTON
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:
Last Name:MILLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 EISENHOWER RD
Mailing Address - Street 2:202C STUDENT HEALTH CENTER
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:16802
Mailing Address - Country:US
Mailing Address - Phone:814-865-4847
Mailing Address - Fax:814-865-8635
Practice Address - Street 1:542 EISENHOWER RD
Practice Address - Street 2:202C STUDENT HEALTH CENTER
Practice Address - City:UNIVERSITY PARK
Practice Address - State:PA
Practice Address - Zip Code:16802
Practice Address - Country:US
Practice Address - Phone:814-865-4847
Practice Address - Fax:814-863-4463
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP449302183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist