Healthcare Provider Details

I. General information

NPI: 1346862026
Provider Name (Legal Business Name): CLARISSA MILLER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2020
Last Update Date: 05/15/2020
Certification Date: 05/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TSAILE MEDICAL CENTER INDIAN RTE 64
TSAILE AZ
86556
US

IV. Provider business mailing address

PO BOX C021
TSAILE AZ
86556-5048
US

V. Phone/Fax

Practice location:
  • Phone: 928-724-3600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS024290
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: