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General NPI Number Information
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NPI Number | 1770170011
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Entity Type | Individual
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Provider Name | MAURA MILLER
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Gender | Female
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Dates
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Enumeration Date | 12/21/2020
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Last Update Date | 12/21/2020
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Provider Practice Location Address
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Address Line | 8830 STATE ROAD 60 W
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City | MITCHELL
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State | IN
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Zip | 47446-7547
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Country | US
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Telephone | 812-849-2425
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Fax |
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Provider Business Mailing Address
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Address Line | 158 EAGLE RIDGE RD
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City | MITCHELL
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State | IN
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Zip | 47446-5492
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Country | US
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Telephone | 812-675-6544
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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 | 26018279A
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License Number State | IN
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