Healthcare Provider Details

I. General information

NPI: 1710258082
Provider Name (Legal Business Name): TERI MILLER R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 E BROADWAY
COUNCIL BLUFFS IA
51503-4419
US

IV. Provider business mailing address

2373 ROLLING HILLS LOOP
COUNCIL BLUFFS IA
51503-8572
US

V. Phone/Fax

Practice location:
  • Phone: 712-329-0930
  • Fax: 712-329-0930
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11035
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19144
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: