MEDICARE: KENNETTA ELESHA 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
1	183500000X	Pharmacist	025640	LA

General Provider Information

NPI Number	:	1396550216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETTA ELESHA MILLER

Provider Business Mailing Address
First Line	:	2520 PLANK RD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70805-8027
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2520 PLANK RD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70805-8027
Country	:	US
Telephone Number	:	225-357-1484
Fax Number	:

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

Provider Enumeration Date	:	02/10/2025
Last Update Date	:	02/10/2025

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