Healthcare Provider Details

I. General information

NPI: 1851397996
Provider Name (Legal Business Name): JOHN RAYMOND MILLER R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WYOMING ST
DAYTON OH
45409-2732
US

IV. Provider business mailing address

5234 SAVINA AVE
DAYTON OH
45415-1138
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-4889
  • Fax: 937-341-8349
Mailing address:
  • Phone: 937-836-6797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number03-2-16791
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: