Provider Demographics
NPI:1609102037
Name:MILLER, CARILYN JEAN (RPH)
Entity Type:Individual
Prefix:
First Name:CARILYN
Middle Name:JEAN
Last Name:MILLER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:CARILYN
Other - Middle Name:
Other - Last Name:SAWYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:721 MECHEM DR STE B
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345-6911
Mailing Address - Country:US
Mailing Address - Phone:575-630-8020
Mailing Address - Fax:575-630-1083
Practice Address - Street 1:721 MECHEM DR STE B
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-6911
Practice Address - Country:US
Practice Address - Phone:575-630-8020
Practice Address - Fax:575-630-1083
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006008183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist