Provider Demographics
NPI:1063678282
Name:MILLER, TERESA OLIVER (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:OLIVER
Last Name:MILLER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 E GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-8593
Mailing Address - Country:US
Mailing Address - Phone:517-548-9511
Mailing Address - Fax:517-548-1005
Practice Address - Street 1:3850 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-8593
Practice Address - Country:US
Practice Address - Phone:517-548-9511
Practice Address - Fax:517-548-1005
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028140183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist