Provider Demographics
NPI:1043414758
Name:MILLER PROFESSIONAL PHARMACY
Entity Type:Organization
Organization Name:MILLER PROFESSIONAL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:816-858-2400
Mailing Address - Street 1:PO BOX 1877
Mailing Address - Street 2:2703 RUNNING HORSE RD STE 1A
Mailing Address - City:PLATTE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64079-1877
Mailing Address - Country:US
Mailing Address - Phone:816-858-2400
Mailing Address - Fax:
Practice Address - Street 1:2703 RUNNING HORSE RD STE 1A
Practice Address - Street 2:#1877
Practice Address - City:PLATTE CITY
Practice Address - State:MO
Practice Address - Zip Code:64079-7707
Practice Address - Country:US
Practice Address - Phone:816-858-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2626490Medicare NSC