Healthcare Provider Details

I. General information

NPI: 1457411795
Provider Name (Legal Business Name): KRISTI MILLER PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2006
Last Update Date: 06/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 S MAIN ST
SWEETWATER TN
37874-2705
US

IV. Provider business mailing address

PO BOX 517
VONORE TN
37885-0517
US

V. Phone/Fax

Practice location:
  • Phone: 423-337-7933
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24291
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: