Healthcare Provider Details

I. General information

NPI: 1164755187
Provider Name (Legal Business Name): ANGIE A. MILLER R. PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 09/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 S MORENCI AVE
MIO MI
48647-2508
US

IV. Provider business mailing address

114 S MORENCI AVE P.O. BOX 1060
MIO MI
48647-2508
US

V. Phone/Fax

Practice location:
  • Phone: 989-826-8989
  • Fax: 989-826-3939
Mailing address:
  • Phone: 989-826-8989
  • Fax: 989-826-3939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302027237
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: