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General NPI Number Information
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NPI Number | 1063029403
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Entity Type | Individual
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Provider Name | RANDALL LEE MILLER
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Gender | Male
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Dates
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Enumeration Date | 09/29/2020
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Last Update Date | 09/29/2020
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Provider Practice Location Address
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Address Line | 959 E LENNON DR
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City | EMORY
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State | TX
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Zip | 75440-5232
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Country | US
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Telephone | 903-473-4523
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Fax | 903-473-4525
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Provider Business Mailing Address
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Address Line | 959 E LENNON DR
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City | EMORY
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State | TX
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Zip | 75440-5232
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Country | US
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Telephone | 903-473-4523
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Fax | 903-473-4525
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 19784
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License Number State | TX
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