Provider Demographics
NPI:1023391190
Name:MILLER, SALLY JO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:JO
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1793 E AVENIDA DE LAS FLORES
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-1522
Mailing Address - Country:US
Mailing Address - Phone:678-523-7553
Mailing Address - Fax:
Practice Address - Street 1:1793 E AVENIDA DE LAS FLORES
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-1522
Practice Address - Country:US
Practice Address - Phone:678-523-7553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH024592183500000X
CARPH65689183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist