Healthcare Provider Details

I. General information

NPI: 1043701857
Provider Name (Legal Business Name): JOHN S MILLER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 07/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 FANNIN ST STE 204
HOUSTON TX
77054-1953
US

IV. Provider business mailing address

13410 EASTPOINT CENTRE DR STE 101
LOUISVILLE KY
40223-4160
US

V. Phone/Fax

Practice location:
  • Phone: 877-662-6633
  • Fax: 502-849-0643
Mailing address:
  • Phone: 877-662-6633
  • Fax: 502-849-0643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number34643
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: