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General NPI Number Information
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NPI Number | 1265128938
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Entity Type | Individual
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Provider Name | MARISSA MILLER
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Gender | Female
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Dates
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Enumeration Date | 04/14/2023
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Last Update Date | 04/14/2023
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Provider Practice Location Address
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Address Line | 14075 HIGHWAY 13 S
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City | SAVAGE
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State | MN
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Zip | 55378-3100
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Country | US
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Telephone | 952-447-1611
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Fax |
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Provider Business Mailing Address
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Address Line | 14501 GRAND AVE APT 334
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City | BURNSVILLE
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State | MN
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Zip | 55306-6601
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Country | US
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Telephone | 814-227-5896
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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 | 125785
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License Number State | MN
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