Provider Demographics
NPI:1518288489
Name:MILLER, MICHELLE L (CPHT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:L
Other - Last Name:LINDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1010 4TH ST
Mailing Address - Street 2:
Mailing Address - City:TWO HARBORS
Mailing Address - State:MN
Mailing Address - Zip Code:55616-1200
Mailing Address - Country:US
Mailing Address - Phone:218-834-7202
Mailing Address - Fax:
Practice Address - Street 1:1010 4TH ST
Practice Address - Street 2:
Practice Address - City:TWO HARBORS
Practice Address - State:MN
Practice Address - Zip Code:55616-1200
Practice Address - Country:US
Practice Address - Phone:218-834-7202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN721908183700000X
MN5101-0701-0085-206183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician