Provider Demographics
NPI:1477571693
Name:MILLER, TIFFANY RENAE (PHARMD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:RENAE
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 1:1937 SW CREST DR
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-3552
Mailing Address - Country:US
Mailing Address - Phone:785-273-1625
Mailing Address - Fax:
Practice Address - Street 1:601 W 11TH ST
Practice Address - Street 2:
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-5025
Practice Address - Country:US
Practice Address - Phone:620-251-1620
Practice Address - Fax:620-251-4730
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-14227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0192500001Medicare ID - Type Unspecified