Provider Demographics
NPI:1144379959
Name:MILLER, CHARLES M (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:M
Last Name:MILLER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 W CARDINAL AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-2605
Mailing Address - Country:US
Mailing Address - Phone:304-233-9058
Mailing Address - Fax:
Practice Address - Street 1:1415 MAIN ST
Practice Address - Street 2:
Practice Address - City:FOLLANSBEE
Practice Address - State:WV
Practice Address - Zip Code:26037-1217
Practice Address - Country:US
Practice Address - Phone:304-527-1004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV6314183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist