Provider Demographics
NPI:1114913712
Name:MILLER, MARYSUE (RPH, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARYSUE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14415 ROBERTA DR
Mailing Address - Street 2:
Mailing Address - City:NORTH HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:15642-1665
Mailing Address - Country:US
Mailing Address - Phone:412-751-4624
Mailing Address - Fax:
Practice Address - Street 1:103 BRADFORD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-6910
Practice Address - Country:US
Practice Address - Phone:724-940-2490
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP035516L1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy