Provider Demographics
NPI:1336486190
Name:MILLER, DAVID WALTER (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WALTER
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 1:5001 E STATE ROAD 64
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-5531
Mailing Address - Country:US
Mailing Address - Phone:941-746-4722
Mailing Address - Fax:941-746-4209
Practice Address - Street 1:5001 E STATE ROAD 64
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-5531
Practice Address - Country:US
Practice Address - Phone:941-746-4722
Practice Address - Fax:941-746-4209
Is Sole Proprietor?:No
Enumeration Date:2013-01-13
Last Update Date:2013-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35534183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist