Provider Demographics
NPI:1275108201
Name:MILLER, ISAAC ELIAS (PHARMD)
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:ELIAS
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3855 N FREEWAY BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-2934
Mailing Address - Country:US
Mailing Address - Phone:916-239-7900
Mailing Address - Fax:
Practice Address - Street 1:3855 N FREEWAY BLVD STE 110
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-2934
Practice Address - Country:US
Practice Address - Phone:916-239-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58667183500000X
CA77504183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist