Provider Demographics
NPI:1134691199
Name:MILLER, ROBERT NATHAN (PHARM-D)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:NATHAN
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 1:69 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-2053
Mailing Address - Country:US
Mailing Address - Phone:208-785-3510
Mailing Address - Fax:208-785-7317
Practice Address - Street 1:69 N PINE ST
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-2053
Practice Address - Country:US
Practice Address - Phone:208-785-3510
Practice Address - Fax:208-785-7317
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-31
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5363183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist