Healthcare Provider Details

I. General information

NPI: 1962519819
Provider Name (Legal Business Name): MERRILL CUSHING MILLER III RPH, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 BATCHELOR RD
APEX NC
27523-5720
US

IV. Provider business mailing address

1200 BATCHELOR RD
APEX NC
27523-5720
US

V. Phone/Fax

Practice location:
  • Phone: 919-367-0795
  • Fax:
Mailing address:
  • Phone: 919-367-0795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10997
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: