Provider Demographics
NPI:1467751669
Name:MILLER, JOHN CLARKE
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CLARKE
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:CLARKE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:1440 W NORTON AVE
Mailing Address - Street 2:M-1
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-6711
Mailing Address - Country:US
Mailing Address - Phone:231-780-3656
Mailing Address - Fax:
Practice Address - Street 1:730 SEMINOLE RD
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-4722
Practice Address - Country:US
Practice Address - Phone:231-780-4706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302019152183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist