MEDICARE: MS. TRACI L 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	149237	UT

General Provider Information

NPI Number	:	1528301298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRACI L MILLER RPH

Provider Business Mailing Address
First Line	:	1919 E 3380 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3968
Country	:	US
Telephone Number	:	801-949-7029
Fax Number	:

Provider Business Practice Location Address
First Line	:	1919 E 3380 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3968
Country	:	US
Telephone Number	:	801-949-7029
Fax Number	:

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

Provider Enumeration Date	:	04/01/2013
Last Update Date	:	04/01/2013

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