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General NPI Number Information
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NPI Number | 1720099807
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Entity Type | Individual
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Provider Name | CHARLES W MILLER RPH
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Gender | Male
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 510 E STONER AVE DEPT 119
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City | SHREVEPORT
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State | LA
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Zip | 71101-4243
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Country | US
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Telephone | 318-221-8411
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Fax | 318-429-5750
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Provider Business Mailing Address
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Address Line | 2111 COUNTY ROAD 4670
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City | ATLANTA
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State | TX
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Zip | 75551-7813
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Country | US
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Telephone | 903-796-9372
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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 | 30787
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License Number State | TX
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