=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487929220
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMYBETH M MILLER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2012
-----------------------------------------------------
Last Update Date | 03/13/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 103 WASHINGTON ST
-----------------------------------------------------
City | ELMIRA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14901-3220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-737-2056
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7381 COUNTY ROUTE 112
-----------------------------------------------------
City | ADDISON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14801-9720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-359-3418
-----------------------------------------------------
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 | 048675
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------