Provider Demographics
NPI:1407271083
Name:MILLER, SHAWN MITCHELL (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:MITCHELL
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 1:223 BERTHOUD TRL
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-9677
Mailing Address - Country:US
Mailing Address - Phone:303-246-7428
Mailing Address - Fax:
Practice Address - Street 1:223 BERTHOUD TRL
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-9677
Practice Address - Country:US
Practice Address - Phone:303-246-7428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0020225183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPHA.0020225OtherPHARMACIST LICENSE