Provider Demographics
NPI:1578539631
Name:MILLER, MITCHELL HOWARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:HOWARD
Last Name:MILLER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2506
Mailing Address - Country:US
Mailing Address - Phone:631-724-3757
Mailing Address - Fax:
Practice Address - Street 1:626 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-6011
Practice Address - Country:US
Practice Address - Phone:631-669-3311
Practice Address - Fax:631-669-7322
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030932183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist