1962516948 NPI number — MILLER PHARMACY

Table of content: (NPI 1962516948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962516948 NPI number — MILLER PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILLER PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1962516948
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
234 MAIN ST
Provider Second Line Business Mailing Address:
PO BOX 916
Provider Business Mailing Address City Name:
COSHOCTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43812-1507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
234 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COSHOCTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43812-1507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-622-1806
Provider Business Practice Location Address Fax Number:
740-622-8460
Provider Enumeration Date:
08/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
740-622-1806

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 020084550 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5999808 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3606475 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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