Provider Demographics
NPI:1609398593
Name:MILLER, ALYSSA DAWN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:DAWN
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47-1 PARK CLUB LN
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5262
Mailing Address - Country:US
Mailing Address - Phone:267-377-6479
Mailing Address - Fax:
Practice Address - Street 1:2000 KENSINGTON AVE
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-4611
Practice Address - Country:US
Practice Address - Phone:716-839-5471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA449622183500000X
NY062206183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist