Provider Demographics
NPI:1114121084
Name:MILLER, NICOLE MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 YELM HWY SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-4986
Mailing Address - Country:US
Mailing Address - Phone:360-438-0081
Mailing Address - Fax:360-438-0082
Practice Address - Street 1:4700 YELM HWY SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-4986
Practice Address - Country:US
Practice Address - Phone:360-438-0081
Practice Address - Fax:360-438-0082
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00069707183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist