Provider Demographics
NPI:1073829081
Name:MILLER, DONNA
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4926 BRAMHOPE LN
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-7407
Mailing Address - Country:US
Mailing Address - Phone:410-461-8542
Mailing Address - Fax:410-461-8542
Practice Address - Street 1:6401 FREDERICK RD
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-3504
Practice Address - Country:US
Practice Address - Phone:410-719-7005
Practice Address - Fax:410-747-1463
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08921183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist