Provider Demographics
NPI:1619267473
Name:MILLER, LUCY M
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 W KALAMAZOO AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-3334
Mailing Address - Country:US
Mailing Address - Phone:269-553-6000
Mailing Address - Fax:269-492-9362
Practice Address - Street 1:418 W KALAMAZOO AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-3334
Practice Address - Country:US
Practice Address - Phone:269-553-6000
Practice Address - Fax:269-492-9362
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302411008183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist