Healthcare Provider Details

I. General information

NPI: 1760585665
Provider Name (Legal Business Name): RICHARD IRVIN MILLER LA 14443
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 RIVERWOOD DR
SAINT ROSE LA
70087-3768
US

IV. Provider business mailing address

400 RIVERWOOD DR
SAINT ROSE LA
70087-3768
US

V. Phone/Fax

Practice location:
  • Phone: 504-236-3320
  • Fax: 504-467-2471
Mailing address:
  • Phone: 504-236-3320
  • Fax: 504-467-2471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14443
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: