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General NPI Number Information
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NPI Number | 1164018628
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Entity Type | Individual
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Provider Name | KELLY MILLER
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Gender | Female
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Dates
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Enumeration Date | 12/17/2020
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Last Update Date | 09/29/2021
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Provider Practice Location Address
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Address Line | 1358 HIGHWAY 141
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City | CHARTER OAK
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State | IA
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Zip | 51439-7522
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Country | US
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Telephone | 712-263-9097
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Fax |
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Provider Business Mailing Address
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Address Line | 1358 HIGHWAY 141
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City | CHARTER OAK
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State | IA
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Zip | 51439-7522
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Country | US
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Telephone | 712-263-9097
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Fax |
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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 | 17851
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License Number State | IA
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