Provider Demographics
NPI:1497879357
Name:MILLER, DOUGLAS P (RPH CCP)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:P
Last Name:MILLER
Suffix:
Gender:M
Credentials:RPH CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-2044
Mailing Address - Country:US
Mailing Address - Phone:609-338-3526
Mailing Address - Fax:
Practice Address - Street 1:2838 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-6326
Practice Address - Country:US
Practice Address - Phone:609-345-5105
Practice Address - Fax:609-345-8892
Is Sole Proprietor?:No
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI18910183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist