Healthcare Provider Details

I. General information

NPI: 1508143207
Provider Name (Legal Business Name): ROBERT W MILLER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5159 FAIR OAKS BLVD
CARMICHAEL CA
95608-5750
US

IV. Provider business mailing address

5159 FAIR OAKS BLVD
CARMICHAEL CA
95608-5750
US

V. Phone/Fax

Practice location:
  • Phone: 916-483-0419
  • Fax: 916-483-7855
Mailing address:
  • Phone: 916-483-0419
  • Fax: 916-483-7855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH 37821
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: