Provider Demographics
NPI:1194864595
Name:MILLER, KENT ALLEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:KENT
Middle Name:ALLEN
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 1:4024 CANNERY WOODS DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:VA
Mailing Address - Zip Code:22812-1246
Mailing Address - Country:US
Mailing Address - Phone:540-828-2047
Mailing Address - Fax:
Practice Address - Street 1:3935 SUNNYSIDE DR
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-2328
Practice Address - Country:US
Practice Address - Phone:540-568-8249
Practice Address - Fax:540-568-8645
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA0202009119183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist