Healthcare Provider Details

I. General information

NPI: 1063808715
Provider Name (Legal Business Name): BRIAN MILLER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 N CROATAN HWY
KILL DEVIL HILLS NC
27948-8978
US

IV. Provider business mailing address

605 VICCARS LN
MANTEO NC
27954-8011
US

V. Phone/Fax

Practice location:
  • Phone: 252-441-2001
  • Fax:
Mailing address:
  • Phone: 651-829-0860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20110
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: