Healthcare Provider Details

I. General information

NPI: 1013626209
Provider Name (Legal Business Name): BLAIR MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2022
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16418 WESTSIDE DR
PLATTSMOUTH NE
68048-6102
US

IV. Provider business mailing address

9701 MARGO ST
LA VISTA NE
68128-4394
US

V. Phone/Fax

Practice location:
  • Phone: 402-296-6900
  • Fax:
Mailing address:
  • Phone: 402-446-2091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17587
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: