Provider Demographics
NPI:1003191347
Name:MILLER, KYLE MATTHEW (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:MATTHEW
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 471
Mailing Address - Street 2:205 CRIMSON CT
Mailing Address - City:OTTOVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45876-0471
Mailing Address - Country:US
Mailing Address - Phone:937-620-3074
Mailing Address - Fax:
Practice Address - Street 1:701 N CABLE RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-1737
Practice Address - Country:US
Practice Address - Phone:419-222-9462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03326858183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist