Provider Demographics
NPI:1407543002
Name:MILLER, KEVIN ROY (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:ROY
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-2244
Mailing Address - Country:US
Mailing Address - Phone:760-344-5732
Mailing Address - Fax:760-344-6772
Practice Address - Street 1:405 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-2244
Practice Address - Country:US
Practice Address - Phone:760-344-5732
Practice Address - Fax:760-344-6772
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98081183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician