Provider Demographics
NPI:1407844913
Name:MILLER, E. LAIRD (RPH)
Entity Type:Individual
Prefix:
First Name:E.
Middle Name:LAIRD
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 1:672 LANIER PARK DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2061
Mailing Address - Country:US
Mailing Address - Phone:770-535-8860
Mailing Address - Fax:770-532-7100
Practice Address - Street 1:672 LANIER PARK DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2061
Practice Address - Country:US
Practice Address - Phone:770-535-8860
Practice Address - Fax:770-532-7100
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist