Provider Demographics
NPI:1053610725
Name:FUTRELL, MILTON T JR
Entity type:Individual
Prefix:MR
First Name:MILTON
Middle Name:T
Last Name:FUTRELL
Suffix:JR
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 1:1240 HOLLAND RD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-6313
Mailing Address - Country:US
Mailing Address - Phone:757-539-6359
Mailing Address - Fax:757-539-0821
Practice Address - Street 1:1240 HOLLAND RD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-6313
Practice Address - Country:US
Practice Address - Phone:757-539-6359
Practice Address - Fax:757-539-0821
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202004043183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist