Healthcare Provider Details

I. General information

NPI: 1679085088
Provider Name (Legal Business Name): AMANDA MARIE MILLER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 SOUTH MAIN STREET
ANTWERP OH
45813
US

IV. Provider business mailing address

3405 COUNTY ROAD 144
ANTWERP OH
45813-9700
US

V. Phone/Fax

Practice location:
  • Phone: 419-258-2068
  • Fax: 419-371-4711
Mailing address:
  • Phone: 419-371-4711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03230389
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: