Healthcare Provider Details

I. General information

NPI: 1134138886
Provider Name (Legal Business Name): KASSANDRA MILLER D. RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 FAIRBURN RD SW
ATLANTA GA
30331-1907
US

IV. Provider business mailing address

5773 CEDAR CROFT CT
LITHONIA GA
30058-3586
US

V. Phone/Fax

Practice location:
  • Phone: 404-691-9627
  • Fax: 404-691-9793
Mailing address:
  • Phone: 770-987-5679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH019451
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: