MEDICARE: MR. RANDOLPH MELVIN MILLER R.PH.

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	8838-040	WI

General Provider Information

NPI Number	:	1871779645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RANDOLPH MELVIN MILLER R.PH.

Provider Business Mailing Address
First Line	:	1303 MAIN ST S
Second Line	:
City	:	HOLMEN
State	:	WI
Zip	:	54636-8927
Country	:	US
Telephone Number	:	608-526-1526
Fax Number	:	608-526-1554

Provider Business Practice Location Address
First Line	:	1303 MAIN ST S
Second Line	:
City	:	HOLMEN
State	:	WI
Zip	:	54636-8927
Country	:	US
Telephone Number	:	608-526-1526
Fax Number	:	608-526-1554

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

Provider Enumeration Date	:	01/11/2008
Last Update Date	:	11/13/2012

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