Healthcare Provider Details

I. General information

NPI: 1932744646
Provider Name (Legal Business Name): JOSHUA MILLER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2019
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4129 SE 29TH ST
DEL CITY OK
73115-2643
US

IV. Provider business mailing address

4129 SE 29TH ST
DEL CITY OK
73115-2643
US

V. Phone/Fax

Practice location:
  • Phone: 405-672-2180
  • Fax: 405-672-2367
Mailing address:
  • Phone: 405-672-2180
  • Fax: 405-672-2367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number47357
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14479
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: