Provider Demographics
NPI:1518936525
Name:MILLER PROFESSIONAL PHARMACY INC
Entity Type:Organization
Organization Name:MILLER PROFESSIONAL PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:816-858-2400
Mailing Address - Street 1:PO BOX 1877
Mailing Address - Street 2:2703 RUNNING HORSE RD STE 1A
Mailing Address - City:PLATTE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64079-1877
Mailing Address - Country:US
Mailing Address - Phone:816-858-2400
Mailing Address - Fax:816-858-5051
Practice Address - Street 1:2703 RUNNING HORSE RD STE 1A
Practice Address - Street 2:#1877
Practice Address - City:PLATTE CITY
Practice Address - State:MO
Practice Address - Zip Code:64079-7707
Practice Address - Country:US
Practice Address - Phone:816-858-2400
Practice Address - Fax:816-858-5051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPS 005109314000000X
MOPS005109333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO601155609Medicaid
MO601155609Medicaid
MO0322450001Medicare NSC