=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073822615
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARRIE LYNN MILLER RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2010
-----------------------------------------------------
Last Update Date | 06/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1107 ROSS ST
-----------------------------------------------------
City | ELGIN
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-438-5735
-----------------------------------------------------
Fax | 803-435-4657
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1830 PORTER CROSS RD
-----------------------------------------------------
City | LUGOFF
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29078-9658
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-319-7288
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 20032
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 0202007813
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 8766
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------