Provider Demographics
NPI:1619576089
Name:MILLER, SHELLY J (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:J
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 1:920 DEER RUN TRL NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-1176
Mailing Address - Country:US
Mailing Address - Phone:502-386-3517
Mailing Address - Fax:
Practice Address - Street 1:1205 N GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-2603
Practice Address - Country:US
Practice Address - Phone:706-226-7033
Practice Address - Fax:706-272-9365
Is Sole Proprietor?:No
Enumeration Date:2020-10-18
Last Update Date:2020-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0271141835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist