Healthcare Provider Details

I. General information

NPI: 1225081052
Provider Name (Legal Business Name): PATRICIA ELLEN MILLER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E MARKET
TROY IL
62294
US

IV. Provider business mailing address

7949 GREEN HEDGE RD
EDWARDSVILLE IL
62025
US

V. Phone/Fax

Practice location:
  • Phone: 618-667-6726
  • Fax: 618-667-6972
Mailing address:
  • Phone: 618-656-1116
  • Fax: 618-659-1816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051037036
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: