Provider Demographics
NPI:1477857217
Name:MILLER, ROBERT STEPHEN (RPH, CPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:STEPHEN
Last Name:MILLER
Suffix:
Gender:M
Credentials:RPH, CPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 SHADOW BAY BLVD NORTH
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779
Mailing Address - Country:US
Mailing Address - Phone:800-642-1652
Mailing Address - Fax:800-439-4160
Practice Address - Street 1:318 SHADOW BAY BLVD NORTH
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779
Practice Address - Country:US
Practice Address - Phone:800-642-1652
Practice Address - Fax:800-439-4160
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS16899183500000X
PARPO29585L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist