Provider Demographics
NPI:1689058315
Name:MILLEDGE, NANCY
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:MILLEDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 E ELK RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:GODDARD
Mailing Address - State:KS
Mailing Address - Zip Code:67052-8551
Mailing Address - Country:US
Mailing Address - Phone:785-466-6810
Mailing Address - Fax:620-584-4044
Practice Address - Street 1:900 E ROSS ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:KS
Practice Address - Zip Code:67026-7849
Practice Address - Country:US
Practice Address - Phone:620-584-4044
Practice Address - Fax:620-584-4044
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11695183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist