Provider Demographics
NPI:1508413873
Name:MILLER, RYAN DANIEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:DANIEL
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26603 72ND AVE NW
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-6273
Mailing Address - Country:US
Mailing Address - Phone:360-629-4400
Mailing Address - Fax:
Practice Address - Street 1:26603 72ND AVE NW
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-6273
Practice Address - Country:US
Practice Address - Phone:360-629-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60969493183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist