Provider Demographics
NPI:1245631316
Name:MILBURN, GENE (RPH)
Entity type:Individual
Prefix:
First Name:GENE
Middle Name:
Last Name:MILBURN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:KS
Mailing Address - Zip Code:66067-2328
Mailing Address - Country:US
Mailing Address - Phone:785-242-2055
Mailing Address - Fax:785-242-0649
Practice Address - Street 1:134 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-2328
Practice Address - Country:US
Practice Address - Phone:785-242-2055
Practice Address - Fax:785-242-0649
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS109170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist