Provider Demographics
NPI:1184022063
Name:MILLER PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:MILLER PHARMACY SERVICES LLC
Other - Org Name:FARMERVILLE DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESDIENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:318-255-7363
Mailing Address - Street 1:208 BOOTS DR
Mailing Address - Street 2:
Mailing Address - City:FARMERVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71241-3102
Mailing Address - Country:US
Mailing Address - Phone:318-368-9711
Mailing Address - Fax:318-368-8567
Practice Address - Street 1:208 BOOTS DR
Practice Address - Street 2:
Practice Address - City:FARMERVILLE
Practice Address - State:LA
Practice Address - Zip Code:71241-3102
Practice Address - Country:US
Practice Address - Phone:318-368-9711
Practice Address - Fax:318-368-8567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2203720Medicaid