=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477571693
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TIFFANY RENAE MILLER PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 601 W 11TH ST
-----------------------------------------------------
City | COFFEYVILLE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67337-5025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-251-1620
-----------------------------------------------------
Fax | 620-251-4730
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1937 SW CREST DR
-----------------------------------------------------
City | TOPEKA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66604-3552
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-273-1625
-----------------------------------------------------
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 | 1-14227
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------