MEDICARE: KENNETH MILLER RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03223768	OH

General Provider Information

NPI Number	:	1063175073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH MILLER RPH

Provider Business Mailing Address
First Line	:	14100 DETROIT AVE
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-4524
Country	:	US
Telephone Number	:	216-226-1600
Fax Number	:

Provider Business Practice Location Address
First Line	:	14100 DETROIT AVE
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-4524
Country	:	US
Telephone Number	:	216-226-1600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2021
Last Update Date	:	10/17/2021

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Directions to “ KENNETH MILLER RPH” Practice Location

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