Healthcare Provider Details

I. General information

NPI: 1003209545
Provider Name (Legal Business Name): KENNETH MILLER PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2015
Last Update Date: 03/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3760 PAXTON AVE
CINCINNATI OH
45209-2306
US

IV. Provider business mailing address

3760 PAXTON AVE
CINCINNATI OH
45209-2306
US

V. Phone/Fax

Practice location:
  • Phone: 513-871-0725
  • Fax:
Mailing address:
  • Phone: 513-871-0725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03129649
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: