Healthcare Provider Details

I. General information

NPI: 1003030255
Provider Name (Legal Business Name): ANDREW CHAPMAN MILLER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 CANAL STREET BROOKS PHARMACY # 605
BRATTLEBORO VT
05301-3395
US

IV. Provider business mailing address

49 TYLER STREET
BRATTLEBORO VT
05301
US

V. Phone/Fax

Practice location:
  • Phone: 802-257-4204
  • Fax: 802-257-4766
Mailing address:
  • Phone: 802-254-8452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3124
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2720
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12566
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: