Provider Demographics
NPI:1043701857
Name:MILLER, JOHN S (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13410 EASTPOINT CENTRE DR
Mailing Address - Street 2:STE 101
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4160
Mailing Address - Country:US
Mailing Address - Phone:877-662-6633
Mailing Address - Fax:502-849-0643
Practice Address - Street 1:7505 FANNIN ST STE 204
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1953
Practice Address - Country:US
Practice Address - Phone:877-662-6633
Practice Address - Fax:502-849-0643
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34643183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist