Provider Demographics
NPI:1578527248
Name:MILLERS OF WYCKOFF INC
Entity Type:Organization
Organization Name:MILLERS OF WYCKOFF INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:201-891-3333
Mailing Address - Street 1:678 WYCKOFF AVE
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-1430
Mailing Address - Country:US
Mailing Address - Phone:201-891-3333
Mailing Address - Fax:201-891-6392
Practice Address - Street 1:678 WYCKOFF AVE
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-1430
Practice Address - Country:US
Practice Address - Phone:201-891-3333
Practice Address - Fax:201-891-6392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7665008Medicaid
NJ0194790001Medicare NSC