Provider Demographics
NPI:1376890541
Name:MILLER, MELISSA LEA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LEA
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 MCANDREWS RD W
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4472
Mailing Address - Country:US
Mailing Address - Phone:701-373-5396
Mailing Address - Fax:
Practice Address - Street 1:2000 CLIFF LAKE RD
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2400
Practice Address - Country:US
Practice Address - Phone:651-688-8947
Practice Address - Fax:651-234-2668
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120796183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist