Healthcare Provider Details

I. General information

NPI: 1487787941
Provider Name (Legal Business Name): LUCAS B MILLER PHARM.D., RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 E 7TH ST
JOPLIN MO
64801-2045
US

IV. Provider business mailing address

3002 SUNSET DR
JOPLIN MO
64804-1380
US

V. Phone/Fax

Practice location:
  • Phone: 417-624-3270
  • Fax:
Mailing address:
  • Phone: 417-483-5262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2004009919
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: