MEDICARE: MRS. PATRICIA ELLEN 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	051037036	IL

General Provider Information

NPI Number	:	1225081052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA ELLEN MILLER RPH

Provider Business Mailing Address
First Line	:	7949 GREEN HEDGE RD
Second Line	:
City	:	EDWARDSVILLE
State	:	IL
Zip	:	62025
Country	:	US
Telephone Number	:	618-656-1116
Fax Number	:	618-659-1816

Provider Business Practice Location Address
First Line	:	101 E MARKET
Second Line	:
City	:	TROY
State	:	IL
Zip	:	62294
Country	:	US
Telephone Number	:	618-667-6726
Fax Number	:	618-667-6972

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	07/08/2007

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