Provider Demographics
NPI:1487833828
Name:MILLERS PHARMACY INC
Entity Type:Organization
Organization Name:MILLERS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-234-2012
Mailing Address - Street 1:111 S COURT SQ
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-3511
Mailing Address - Country:US
Mailing Address - Phone:870-234-2012
Mailing Address - Fax:870-234-5574
Practice Address - Street 1:111 S COURT SQ
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-3511
Practice Address - Country:US
Practice Address - Phone:870-234-2012
Practice Address - Fax:870-234-5574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR133740716Medicaid
0633020001Medicare NSC