Healthcare Provider Details

I. General information

NPI: 1295168631
Provider Name (Legal Business Name): KEVIN BRADLEY MILLER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 QUALITY DR
VACAVILLE CA
95688-9494
US

IV. Provider business mailing address

2408 WESTERNESSE RD
DAVIS CA
95616-3092
US

V. Phone/Fax

Practice location:
  • Phone: 707-312-0679
  • Fax:
Mailing address:
  • Phone: 530-400-7565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0020045
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number72203
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: