Provider Demographics
NPI:1497064026
Name:MILLER, MORAG R (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MORAG
Middle Name:R
Last Name:MILLER
Suffix:
Gender:F
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:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:IN
Mailing Address - Zip Code:46571-0157
Mailing Address - Country:US
Mailing Address - Phone:260-593-2252
Mailing Address - Fax:260-593-2150
Practice Address - Street 1:101 N MAIN
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:IN
Practice Address - Zip Code:46571
Practice Address - Country:US
Practice Address - Phone:260-593-2252
Practice Address - Fax:260-593-2150
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26012687A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100298290AMedicaid
IN100298290AMedicaid