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General NPI Number Information
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NPI Number | 1467701508
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Entity Type | Individual
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Provider Name | LACEY JAY MILLER
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Gender | Female
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Dates
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Enumeration Date | 09/05/2012
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Last Update Date | 07/17/2014
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Provider Practice Location Address
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Address Line | 3801 MIRANDA AVE
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City | PALO ALTO
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State | CA
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Zip | 94304-1207
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Country | US
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Telephone | 650-493-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 689 ROBLE AVE 2B
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City | MENLO PARK
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State | CA
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Zip | 94025-4861
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Country | US
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Telephone | 706-339-6385
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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 | RPH026854
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License Number State | GA
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