Healthcare Provider Details

I. General information

NPI: 1306669551
Provider Name (Legal Business Name): MADELINE HOPE MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 E COMMERCE ST
HERNANDO MS
38632-2433
US

IV. Provider business mailing address

3433 SUNDIAL DR
HERNANDO MS
38632-8332
US

V. Phone/Fax

Practice location:
  • Phone: 615-851-7115
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number48073
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberT-102191
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: