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General NPI Number Information
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NPI Number | 1679973168
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Entity Type | Individual
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Provider Name | ADAM MILLER
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Gender | Male
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Dates
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Enumeration Date | 09/03/2014
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Last Update Date | 09/03/2014
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Provider Practice Location Address
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Address Line | 1585 RANDOLPH AVE
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City | SAINT PAUL
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State | MN
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Zip | 55105-2149
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Country | US
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Telephone | 651-698-6502
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Fax | 651-698-4834
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Provider Business Mailing Address
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Address Line | 6817 BUCKINGHAM RD
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City | WOODBURY
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State | MN
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Zip | 55125-3818
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Country | US
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Telephone | 651-340-6999
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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 | 121904
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License Number State | MN
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