Provider Demographics
NPI:1073667242
Name:MILLER, GARY STEVEN
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:STEVEN
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16501 N EL MIRAGE RD # 205
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-3600
Mailing Address - Country:US
Mailing Address - Phone:623-583-9665
Mailing Address - Fax:
Practice Address - Street 1:13503 W CAMINO DEL SOL
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-4439
Practice Address - Country:US
Practice Address - Phone:623-584-0501
Practice Address - Fax:623-546-5538
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7746183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist