Provider Demographics
NPI:1164755187
Name:MILLER, ANGIE A (R PH)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:A
Last Name:MILLER
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 S MORENCI AVE
Mailing Address - Street 2:P.O. BOX 1060
Mailing Address - City:MIO
Mailing Address - State:MI
Mailing Address - Zip Code:48647-2508
Mailing Address - Country:US
Mailing Address - Phone:989-826-8989
Mailing Address - Fax:989-826-3939
Practice Address - Street 1:114 S MORENCI AVE
Practice Address - Street 2:
Practice Address - City:MIO
Practice Address - State:MI
Practice Address - Zip Code:48647-2508
Practice Address - Country:US
Practice Address - Phone:989-826-8989
Practice Address - Fax:989-826-3939
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027237183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist