MEDICARE: CHAD RUSSELL 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	26020465A	IN

General Provider Information

NPI Number	:	1578164141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAD RUSSELL MILLER

Provider Business Mailing Address
First Line	:	3216 N 50 W
Second Line	:
City	:	COLUMBIA CITY
State	:	IN
Zip	:	46725-7842
Country	:	US
Telephone Number	:	260-609-8125
Fax Number	:

Provider Business Practice Location Address
First Line	:	402 W PLAZA DR
Second Line	:
City	:	COLUMBIA CITY
State	:	IN
Zip	:	46725-1051
Country	:	US
Telephone Number	:	260-244-4400
Fax Number	:

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

Provider Enumeration Date	:	11/02/2020
Last Update Date	:	11/02/2020

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Directions to “ CHAD RUSSELL MILLER ” Practice Location

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