Provider Demographics
NPI:1023222940
Name:MILLER, RANDY DAVID (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:DAVID
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 STONY HILL RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-1030
Mailing Address - Country:US
Mailing Address - Phone:203-448-1030
Mailing Address - Fax:
Practice Address - Street 1:7 STONY HILL RD
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-1030
Practice Address - Country:US
Practice Address - Phone:203-448-1030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22851183500000X
CTCT10717183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist