MEDICARE: STEVEN R 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	0015555	OR
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	0015555	OR

General Provider Information

NPI Number	:	1780132498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN R MILLER PHARMD

Provider Business Mailing Address
First Line	:	7591 CRATER LAKE HWY
Second Line	:
City	:	WHITE CITY
State	:	OR
Zip	:	97503-1663
Country	:	US
Telephone Number	:	541-826-4414
Fax Number	:	541-826-8366

Provider Business Practice Location Address
First Line	:	7591 CRATER LAKE HWY
Second Line	:
City	:	WHITE CITY
State	:	OR
Zip	:	97503-1663
Country	:	US
Telephone Number	:	541-826-4414
Fax Number	:	541-826-8366

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

Provider Enumeration Date	:	09/12/2016
Last Update Date	:	11/19/2020

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