Healthcare Provider Details

I. General information

NPI: 1467868661
Provider Name (Legal Business Name): KELLEY MILLER AUTEN PHARMD, CPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELLEY MILLER PHARMD

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 N CHURCH ST STE 300
GREENSBORO NC
27401
US

IV. Provider business mailing address

1126 N CHURCH ST STE 300
GREENSBORO NC
27401-1037
US

V. Phone/Fax

Practice location:
  • Phone: 336-938-0800
  • Fax: 336-938-0757
Mailing address:
  • Phone: 336-938-0800
  • Fax: 336-938-0757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24253
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number700102
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: