Healthcare Provider Details

I. General information

NPI: 1083166326
Provider Name (Legal Business Name): WHITNEY MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2016
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 EAST ASH AVE
DECATUR IL
62526
US

IV. Provider business mailing address

5750 COUNTY ROAD 1175 N
MC LEANSBORO IL
62859-4277
US

V. Phone/Fax

Practice location:
  • Phone: 217-872-1758
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051299854
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: