Provider Demographics
NPI:1124545785
Name:MILLER, WILLIAM WALTON IV (PHARMACIST)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WALTON
Last Name:MILLER
Suffix:IV
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 MCCULLOUGH BLVD
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-7101
Mailing Address - Country:US
Mailing Address - Phone:662-620-9606
Mailing Address - Fax:662-620-9603
Practice Address - Street 1:1776 MCCULLOUGH BLVD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801
Practice Address - Country:US
Practice Address - Phone:662-620-9606
Practice Address - Fax:662-620-9603
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-09678183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist