1104159409 NPI number — DR. LENORA DANETTE MILLER PHARMD.

Table of content: DR. LENORA DANETTE MILLER PHARMD. (NPI 1104159409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104159409 NPI number — DR. LENORA DANETTE MILLER PHARMD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
LENORA
Provider Middle Name:
DANETTE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104159409
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1330
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOULTON
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04730-1330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-203-0919
Provider Business Mailing Address Fax Number:
207-532-4793

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
137 NORTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOULTON
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04730-1832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-532-6876
Provider Business Practice Location Address Fax Number:
207-532-4793
Provider Enumeration Date:
09/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  PR5379 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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