Provider Demographics
NPI:1003021288
Name:MILLER, JEANIE STANLEY (PD)
Entity Type:Individual
Prefix:
First Name:JEANIE
Middle Name:STANLEY
Last Name:MILLER
Suffix:
Gender:F
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 GOLD SMITH DR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-3357
Mailing Address - Country:US
Mailing Address - Phone:410-848-4461
Mailing Address - Fax:
Practice Address - Street 1:205 SAINT MARK WAY
Practice Address - Street 2:UNIT B
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21158-4103
Practice Address - Country:US
Practice Address - Phone:410-848-1618
Practice Address - Fax:410-848-1460
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09721183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist