Healthcare Provider Details

I. General information

NPI: 1902448699
Provider Name (Legal Business Name): RYAN JEFFREY MILLER PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2019
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3040 EVANS ST
GREENVILLE NC
27834-3176
US

IV. Provider business mailing address

165 COUNTRY CLUB DR
GRAND ISLAND NY
14072-2584
US

V. Phone/Fax

Practice location:
  • Phone: 252-355-6450
  • Fax: 252-378-3751
Mailing address:
  • Phone: 716-400-3226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number066305
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number29466
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: