1245712116 NPI number — DR. DAVID JOSEPH MILLER RPH, PHD

Table of content: DR. DAVID JOSEPH MILLER RPH, PHD (NPI 1245712116)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245712116 NPI number — DR. DAVID JOSEPH MILLER RPH, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
DAVID
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
RPH, PHD
Provider Gender Code:
M

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:
1245712116
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
KEYSTONE PHARMACY
Provider Second Line Business Mailing Address:
4021 CASCADE RD SE SUITE 50
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-974-9792
Provider Business Mailing Address Fax Number:
616-464-3469

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4021 CASCADE RD SE
Provider Second Line Business Practice Location Address:
SUITE 50
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-974-9792
Provider Business Practice Location Address Fax Number:
616-464-3469
Provider Enumeration Date:
09/06/2018

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:  5302027363 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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