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General NPI Number Information
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NPI Number | 1265644017
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Entity Type | Individual
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Provider Name | MARK S MILLER PHARMD.
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Gender | Male
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 450 OLD ABE RD
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City | LAC DU FLAMBEAU
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State | WI
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Zip | 54538-9682
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Country | US
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Telephone | 715-356-6813
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Fax |
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Provider Business Mailing Address
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Address Line | 450 OLD ABE RD
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City | LAC DU FLAMBEAU
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State | WI
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Zip | 54538-9682
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Country | US
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Telephone | 715-356-6813
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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 | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number |
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License Number State | IL
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