Healthcare Provider Details

I. General information

NPI: 1699019257
Provider Name (Legal Business Name): JOHN ANTHONY MILLER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11350 S CICERO AVE
ALSIP IL
60803-2830
US

IV. Provider business mailing address

8113 W ROSEBURY DR
FRANKFORT IL
60423-2402
US

V. Phone/Fax

Practice location:
  • Phone: 708-293-1122
  • Fax: 708-293-1144
Mailing address:
  • Phone: 708-253-7763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051040757
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: