Provider Demographics
NPI:1174856793
Name:MILLER, STEPHEN JOE (RPH)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JOE
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 1:9159 SE 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-3761
Mailing Address - Country:US
Mailing Address - Phone:503-771-0274
Mailing Address - Fax:503-771-2835
Practice Address - Street 1:9159 SE 82ND AVE
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-3761
Practice Address - Country:US
Practice Address - Phone:503-771-0274
Practice Address - Fax:503-771-2835
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6890183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist