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NPI Code Detail

MEDICARE: KELLY LYNN MILLER

MEDICARE: KELLY LYNN MILLER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist16421-040WI

General Provider Information

NPI Number : 1235764952
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY LYNN MILLER
Provider Business Mailing Address
First Line : 10275 W PLUM TREE CIR APT 102
Second Line :
City : HALES CORNERS
State : WI
Zip : 53130-2658
Country : US
Telephone Number : 319-310-4230
Fax Number :
Provider Business Practice Location Address
First Line : 1130 W SUNSET DR
Second Line :
City : WAUKESHA
State : WI
Zip : 53189-8422
Country : US
Telephone Number : 262-446-5169
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2020
Last Update Date : 03/04/2020

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