MEDICARE: KEVIN BRADLEY MILLER PHARMD

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
1	183500000X	Pharmacist	0020045	CO
2	183500000X	Pharmacist	72203	CA

General Provider Information

NPI Number	:	1295168631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN BRADLEY MILLER PHARMD

Provider Business Mailing Address
First Line	:	2408 WESTERNESSE RD
Second Line	:
City	:	DAVIS
State	:	CA
Zip	:	95616-3092
Country	:	US
Telephone Number	:	530-400-7565
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 QUALITY DR
Second Line	:
City	:	VACAVILLE
State	:	CA
Zip	:	95688-9494
Country	:	US
Telephone Number	:	707-312-0679
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2013
Last Update Date	:	04/03/2026

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