Provider Demographics
NPI:1073895199
Name:MILLER, DEREK ALAN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:ALAN
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 PACHA PKWY
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-4831
Mailing Address - Country:US
Mailing Address - Phone:319-499-6006
Mailing Address - Fax:319-499-6007
Practice Address - Street 1:625 PACHA PKWY
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-4831
Practice Address - Country:US
Practice Address - Phone:319-499-6006
Practice Address - Fax:319-499-6007
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19159183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist