Healthcare Provider Details

I. General information

NPI: 1518170281
Provider Name (Legal Business Name): SHANNON A MILLER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7975 LAKE UNDERHILL RD SUITE 200
ORLANDO FL
32822-8202
US

IV. Provider business mailing address

729 GLEN EAGLE DR
WINTER SPRINGS FL
32708-5915
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-6574
  • Fax: 407-303-6839
Mailing address:
  • Phone: 407-303-6830
  • Fax: 407-303-6839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPS31738
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: