Provider Demographics
NPI:1184217887
Name:MILLER, OSGOOD ANDREW (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:OSGOOD
Middle Name:ANDREW
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 PINERIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4954
Mailing Address - Country:US
Mailing Address - Phone:770-228-6197
Mailing Address - Fax:
Practice Address - Street 1:566 S 8TH ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4212
Practice Address - Country:US
Practice Address - Phone:770-227-9432
Practice Address - Fax:770-229-4078
Is Sole Proprietor?:No
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13212183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA13212OtherSTATE LICENSE