Healthcare Provider Details

I. General information

NPI: 1720196082
Provider Name (Legal Business Name): ROGER IRVING MILLER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 DOYLE ST E
TOCCOA GA
30577-2007
US

IV. Provider business mailing address

6932 PREACHER SAVAGE RD
TOCCOA GA
30577-9124
US

V. Phone/Fax

Practice location:
  • Phone: 706-886-2151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number014222
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier014222
Identifier TypeOTHER
Identifier StateGA
Identifier IssuerLICENSE NUMBER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: