Provider Demographics
NPI:1073822615
Name:MILLER, CARRIE LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYNN
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 1:1830 PORTER CROSS RD
Mailing Address - Street 2:
Mailing Address - City:LUGOFF
Mailing Address - State:SC
Mailing Address - Zip Code:29078-9658
Mailing Address - Country:US
Mailing Address - Phone:803-319-7288
Mailing Address - Fax:
Practice Address - Street 1:1107 ROSS ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045
Practice Address - Country:US
Practice Address - Phone:803-438-5735
Practice Address - Fax:803-435-4657
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20032183500000X
VA0202007813183500000X
SC8766183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist