Provider Demographics
NPI:1508469461
Name:MILLER, ANITA MARIE (RP)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 ALASKA CIR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-2161
Mailing Address - Country:US
Mailing Address - Phone:402-992-3318
Mailing Address - Fax:
Practice Address - Street 1:2107 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4618
Practice Address - Country:US
Practice Address - Phone:402-371-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11984183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist